小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者的疗效及安全性评价

Efficacy and safety evaluation of low-dose nitroglycerin combined with clopidogrel for patients with coronary heart disease and angina pectoris

目的研究小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者的疗效及安全性。方法选取2019年4月至2021年11月山丹县人民医院收治的96例冠心病心绞痛患者为研究对象,采用随机数字表法将患者分为常规组和试验组,每组各48例。常规组中男30例、女18例,年龄47~76(61.55±7.31)岁,采用氯吡格雷治疗;试验组中男29例、女19例,年龄46~77(62.35±6.89)岁,采用小剂量硝酸甘油(0.2mg/次)联合氯吡格雷治疗。比较两组临床疗效、治疗前、治疗3个月后心绞痛发作情况、心功能指标[舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值(E/A)、射血分数(EF)、心排出量(CO)、心脏指数(CI)]、血小板颗粒膜蛋白(GMP140)、高迁移率族蛋白B1(HMGB1)、白细胞介素-18(IL-18)、C反应蛋白(CRP)水平及不良反应。统计学方法采用t检验、χ^(2)检验。结果试验组总有效率为95.83%(46/48),高于常规组[81.25%(39/48)],差异有统计学意义(χ^(2)=5.031,P=0.025);治疗3个月后试验组心绞痛发作次数、发作持续时间低于常规组[(0.47±0.12)次/d比(0.68±0.19)次/d、(3.25±1.03)min比(6.17±1.22)min],差异均有统计学意义(t=6.474、12.670,均P<0.05);治疗3个月后试验组E/A、EF、CO、CI均高于常规组(t=3.458、7.261、3.997、3.472,均P<0.05);治疗3个月后试验组血清GMP140、HMGB1、IL-18、CRP水平低于常规组(t=7.099、8.729、9.721、5.171,均P<0.05);试验组不良反应总发生率为10.42%(5/48),与常规组[6.25%(3/48)]相比,差异无统计学意义(χ^(2)=0.136,P=0.712)。结论小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者可进一步提升疗效,可有效缩短心绞痛发作时间,改善心功能,促进病情恢复,且安全性高。

Objective To study the efficacy and safety of low-dose nitroglycerin combined with clopidogrel in the treatment of patients with coronary heart disease and angina pectoris.Methods Ninety-six patients with coronary heart disease and angina pectoris treated in Shandan County People's Hospital from April 2019 to November 2021 were selected as the research objects.The patients were divided into a routine group and an experimental group by the random number table method,with 48 cases in each group.There were 30 males and 18 females in the routine group;they were 47-76(61.55±7.31)years old.There were 29 males and 19 females in the experimental group;they were 47-77(62.35±6.89)years old.The routine group were treated with clopidogrel,and the experimental group with low-dose nitroglycerin(0.2mg/time)and clopidogrel.The clinical efficacies,angina attack,cardiac function indicators[ratio of early diastolic mitral valve blood flow velocity to late diastolic mitral valve blood flow velocity(E/A),ejection fraction(EF),cardiac output(CO),and cardiac index(CI)],and levels of platelet granule membrane protein(GMP140),high mobility group box protein B1(HMGB1),interleukin-18(IL-18),and C-reactive protein(CRP)before and 3 months after the treatment,and adverse reactions were compared between these two groups.t and χ^(2) tests were applied.Results The total effective rate of the experimental group was higher than that of the routine group[95.83%(46/48)vs.81.25%(39/48)],with a statistical difference(χ^(2)=5.031,P=0.025).Three months after the treatment,the frequency and duration of angina pectoris in the experimental group were lower than those in the conventional group[(0.47±0.12)time/d vs.(0.68±0.19)time/d and(3.25±1.03)min vs.(6.17±1.22)min],with statistical differences(t=6.474 and 12.670;both P<0.05).Three months after the treatment,the E/A,EF,CO,and CI in the experimental group were higher than those in the routine group(t=3.458,7.261,3.997,and 3.472;all P<0.05).Three months after the treatment,the serum levels of GMP140,HMGB1,IL-18,and CRP in the experimental group were lower than those in the routine group(t=7.099,8.729,9.721,and 5.171;all P<0.05).The total incidences of adverse reactions in the experimental group and the routine group were 10.42%(5/48)and 6.25%(3/48),respectively,with no statistical difference(χ^(2)=0.136,P=0.712).Conclusion Low-dose nitroglycerin combined with clopidogrel in the treatment of patients with coronary heart disease and angina pectoris can further improve the efficacy and their cardiac function and recovery,and effectively shorten the attack time of angina pectoris,with high safety.