硫酸氢氯吡格雷与替格瑞洛治疗急性冠状动脉综合征患者的临床研究

Clinical trial of clopidogrel bisulfate and ticagrelor in the treatment of acute coronary syndrome

目的观察硫酸氢氯吡格雷与替格瑞洛治疗急性冠状动脉综合征的临床疗效及对患者血脂的影响。方法经皮冠状动脉介入术的急性冠状动脉综合征患者按照抗血小板聚集药物的不同,将其分为氯吡格雷组和替格瑞洛组。氯吡格雷组给予硫酸氢氯吡格雷片75 mg,阿托伐他汀钙片20 mg,阿司匹林肠溶片100 mg,每日1次,口服;替格瑞洛组给予阿托伐他汀钙片20 mg,每日1次,阿司匹林肠溶片100 mg,每日1次,替格瑞洛片90 mg,每日2次,口服。2组均连续治疗1个月。比较2组患者的临床疗效、中性粒细胞/淋巴细胞比(NLR)、低密度脂蛋白胆固醇(LDL-C)、血小板最大聚集率以及药物不良反应发生情况。结果氯吡格雷组144例和替格瑞洛组145例。替格瑞洛组治疗后总有效率为86.90%,高于氯吡格雷组的75.00%,差异有统计学意义(P<0.05)。治疗后,氯吡格雷组和替格瑞洛组的NLR水平分别为3.26±0.15和3.10±0.11;LDL-C水平分别为(2.24±0.14)和(1.77±0.16)mmol·L^(-1),差异有统计学意义(P<0.05)。氯吡格雷组患者在术后24 h、7 d、28 d的血小板最大聚集率分别为(62.38±16.24)%、(51.45±12.35)%、(42.42±10.52)%,替格瑞格组分别为(51.48±12.45)%、(41.08±8.33)%、(28.95±5.56)%,差异均有统计学意义(均P<0.05)。2组患者的药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论替格瑞洛与阿托伐他汀联合阿司匹林治疗急性冠状动脉综合征的临床效果确切,且降脂结果明显,安全性高。

Objective To observe the clinical efficacy of clopidogrel sulfate and ticagrelor in the treatment of acute coronary syndrome and the effect on patients’blood lipids.Methods Patients with acute coronary syndrome who were admitted to our hospital for percutaneous coronary intervention were divided into clopidogrel group and ticagrelor group according to the different antiplatelet aggregation drugs.The clopidogrel group was treated with clopidogrel hydrogen sulfate tablets 75 mg,atorvastatin calcium tablets 20 mg and aspirin enteric tablets 100 mg once a day,and the ticagrelor group was treated with atorvastatin calcium tablets 20 mg,aspirin enteric tablets 100 mg once a day and ticagrelor tablets 90 mg twice a day,and both groups were treated continuously for one month.The clinical efficacy,neutrophil/lymphocyte ratio(NLR),low-density lipoprotein cholesterol(LDL-C),maximum platelet agglutination rate,and the occurrence of adverse drug reactions were compared between the two groups.Results There were 144 cases in clopidogrel group and 145 cases in ticagrelor group.The total effective rate after treatment was 86.90%in the ticagrelor group,higher than 75.00%in the clopidogrel group,and the difference was statistically significant(P<0.05).After treatment,NLR levels in clopidogrel group and ticagrelor group were 3.26±0.15 and 3.10±0.11;LDL-C levels were(2.24±0.14)and(1.77±0.16)mmol·L^(-1);the difference were statistically significant(P<0.05).In the clopidogrel group,the maximum platelet aggregation rates at 24 h,7 d and 28 d after surgery were(62.38±16.24)%,(51.45±12.35)%,(42.42±10.52)%,which in the ticagrelor group were(51.48±12.45)%,(41.08±8.33)%,(28.95±5.56)%,and there were statistically significant differences between ticagrelor group and clopidogrel group(all P<0.05).The incidences of adverse drug reactions in the two groups was not statistically significant(P>0.05).Conclusion The clinical effect of ticagrelor and atorvastatin combined with aspirin in the treatment of acute coronary syndrome is precise and effective,and the lipid-lowering results are obvious and safe.