替格瑞洛在急性冠脉综合征伴重度肾功能不全患者介入治疗后的临床应用研究

Clinical study of Ticagrelor in patients undergoing PCI with the acute coronary syndrome and severe renal insufficiency

目的 观察替格瑞洛治疗行经皮冠状动脉介入治疗(PCI)的急性冠脉综合征伴重度肾功能不全患者的疗效和安全性。方法 回顾性分析2018年2月至2020年5月于粤北人民医院心血管内科住院行PCI的急性冠脉综合征伴重度肾功能不全患者(e GFR<30 ml/min·1.73 m^(2))102例,分为替格瑞洛组(90 mg 2/d,n=42)和氯吡格雷组(75 mg,1/d,n=60),追踪随访12个月主要不良心血管事件(MACEs)和出血事件的发生率。采用SPSS 23.0统计软件对数据进行分析。结果 替格瑞洛组与氯吡格雷组总体心脏不良事件发生率比较无统计学差异(P=0.664);替格瑞洛组总出血事件发生率高于氯吡格雷组(P=0.036)。结论 急性冠脉综合征伴重度肾功能不全患者在PCI术后应用替格瑞洛较氯吡格雷无法降低心脏不良事件,且有导致出血风险增加风险。

Objective To observe the efficacy and safety of tegrel in the treatment of acute coronary syndrome with severe renal insufficiency after PCI.Methods Retrospective analysis of 102 patients with acute coronary syndrome with severe renal insufficiency(eGFR <30 ml/min-1.73 m^(2)) hospitalized for PCI at the Department of Cardiovascular Medicine,Guangdong North People’s Hospital from February 2018 to May 2020,divided into the tegretol group(90 mg,2/d,n=42) and the clopidogrel group(75 mg,1/d,n=60).The incidence of major adverse cardiovascular events(MACEs) and bleeding events were followed up for 12 months.SPSS 23.0 statistical software was used to analyze the data.Results There was no significant difference in the incidence of adverse cardiac events between the ticagrelor group and the clopidogrel group(P=0.664);the incidence of total bleeding events in the ticagrelor group was higher than that in the clopidogrel group(P=0.036).Conclusion The use of ticagrelor in patients with the acute coronary syndrome with severe renal insufficiency after PCI cannot reduce adverse cardiac events compared with clopidogrel,and there is an increased risk of bleeding.