氯吡格雷联合瑞舒伐他汀与依折麦布治疗冠心病并发急性心肌梗死患者的临床疗效及安全性

Clinical effect and safety of clopidogrel combined with rivastatin and ezetimibe in the treatment of coronary heart disease patients complicated with acute myocardial infarction

目的 探讨氯吡格雷联合瑞舒伐他汀与依折麦布治疗冠心病并发急性心肌梗死患者的临床疗效及安全性。方法 回顾性选取2021年福建中医药大学附属第二人民医院收治的冠心病并发急性心肌梗死患者100例,依据用药方法分为A组和B组,各50例。A组患者予以氯吡格雷联合瑞舒伐他汀治疗,B组患者在A组基础上予以依折麦布治疗,2组均治疗3个月。比较2组临床疗效,治疗前及治疗3个月后凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)]、心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、B型脑钠肽(BNP)]、心功能指标[左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室轴短缩率(LVSF)、室壁运动积分指数(WMSI)]、炎性因子[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、一氧化氮(NO)、单核细胞趋化因子-1(MCP-1)、白介素-1(IL-1)、生长分化因子15(GDF-15)、血管内皮生长因子(VEGF)、可溶性E选择素(sE-selectin)],不良反应发生率。结果 B组患者总有效率为94.00%,高于A组的80.00%(χ^(2)=4.332,P=0.037)。治疗3个月后,2组APTT、TT、PT均较治疗前延长,血清CK-MB、cTnI、BNP水平及WMSI均较治疗前降低,LAD、LVEDD、LVESD均较治疗前缩小,LVEF、LVSF均较治疗前升高,且B组APTT、TT、PT较A组更长,血清CK-MB、cTnI、BNP水平及WMSI较A组更低,LAD、LVEDD、LVESD较A组更小,LVEF、LVSF较A组更高(P<0.05)。治疗3个月后,2组血清TNF-α、hs-CRP、MCP-1、IL-1、GDF-15、VEGF、sE-selectin水平均较治疗前降低,血清NO水平较治疗前升高,且B组血清TNF-α、hs-CRP、MCP-1、IL-1、GDF-15、VEGF、sE-selectin水平较A组更低,血清NO水平较A组更高(P<0.05)。B组不良反应总发生率为6.00%,与A组的4.00%比较,差异无统计学意义(P=1.000)。结论 氯吡格雷联合瑞舒伐他汀与依折麦布治疗冠心病并发急性心肌梗死的临床疗效较佳,可有效地改善机体凝血功能及心功能,减轻炎性反应,且安全性较好。

Objective To discuss the clinical effect and safety of clopidogrel combined with rivastatin and ezetimibe in the treatment of coronary heart disease patients complicated with acute myocardial infarction. Methods A total of 100 cases of coronary heart disease patients complicated with acute myocardial infarction were selected from the Second Affiliated People′s Hospital of Fujian University of Traditional Chinese Medicine in 2021, and they were divided into group A and group B according to treatment therapy, 50 cases in each group. Patients in group A were treated with clopidogrel combined with rivastatin, patients in group B were treated with ezetimibe, both groups were treated for 3 months. Clinical effect, coagulation function indexes(APTT, TT, PT), myocardial injury markers(CK-MB, cTnI, BNP), cardiac function indexes(LAD, LVEDD, LVESD, LVEF, LVSF, WMSI), inflammatory factors(TNF-α, hs-CRP, NO, MCP-1, IL-1, GDF-15, VEGF, sE-selectin) before and after 3 months of treatment, incidence of adverse reactions were compared between the two groups. Results Total effective rate of group B was 94.00%, which was higher than 80.00% of group A(χ^(2)=4.332, P=0.037). After 3 months of treatment, APTT, TT, PT in the two groups were longer than those before treatment, serum levels of CK-MB, cTnI, BNP and WMSI were lower than those before treatment, LAD, LVEDD, LVESD were less than those before treatment, LVEF, LVSF were higher than those before treatment, and group B of APTT, TT, PT were longer than those of group A, serum levels of CK-MB, cTnI, BNP and WMSI were lower than those of group A, LAD, LVEDD, LVESD were less than those of group A, LVEF, LVSF were higher than those of group A(P<0.05). After 3 months of treatment, serum levels of TNF-α, hs-CRP, MCP-1, IL-1, GDF-15, VEGF, sE-selectin in the two groups were lower than those before treatment, serum NO level was higher than that before treatment, and group B of serum levels of TNF-α, hs-CRP, MCP-1, IL-1, GDF-15, VEGF, sE-selectin were lower than those of group A, serum NO level was higher than that of group A(P<0.05). There was no significant difference of incidence of adverse reactions between the group B(6.00%)and the group A(4.00%)(P=1.000). Conclusion Clopidogrel combined with rivastatin and ezetimibe have better effect in the treatment of coronary heart disease patients complicated with acute myocardial infarction, which can more effectively improve the coagulation function and cardiac function of patients, reduce inflammatory reactions, and with high safety.