小剂量替格瑞洛联合阿托伐他汀钙片治疗冠心病不稳定型心绞痛的疗效及安全性分析

Efficacy and safety analysis of low dose ticagrelor combined with atorvastatin calcium tablet in treating coronary heart disease unstable angina pectoris

目的探讨小剂量替格瑞洛联合阿托伐他汀钙片用于冠心病不稳定型心绞痛的疗效及安全性。方法选取冠心病不稳定型心绞痛患者90例,根据随机数字表法分为小剂量组与常规剂量组,每组45例。常规治疗基础上,小剂量组口服替格瑞洛首剂量120 mg,之后调整至60毫克/次,2次/天;口服阿托伐他汀钙片20毫克/次,1次/天。常规治疗基础上,常规剂量组口服替格瑞洛首剂量180 mg,之后调整至90毫克/次,2次/天,阿托伐他汀钙片用法、用量同小剂量组。两组均持续治疗12周。比较两组治疗前及治疗12周后血清炎症因子[高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6和肿瘤坏死因子-α(TNF-α)]、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和舒张末期室间隔厚度(IVST)]、心肌酶谱和心肌损伤指标[基质金属蛋白酶-9(MMP-9)、1型组织纤溶酶原激活物抑制剂(tPAI-1)、可溶性细胞间黏附因子-1(sICAM-1)、心肌肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)]及临床疗效和不良反应发生率。结果治疗12周后,两组hs-CRP、IL-6、TNF-α水平较治疗前降低(P<0.05),组间比较,差异无统计学意义(P>0.05)。治疗12周后,两组LVEF较治疗前升高(P<0.05),LVEDD、IVST较治疗前降低(P<0.05),组间比较,差异无统计学意义(P>0.05)。治疗12周后,两组MMP-9、tPAI-1、sICAM-1、cTnI、NT-proBNP水平较治疗前降低(P<0.05),组间比较差异无统计学意义(P>0.05)。治疗12周后,小剂量组总有效率与常规剂量组比较,差异无统计学意义(P>0.05),不良反应发生率低于常规剂量组(P<0.05)。结论小剂量替格瑞洛联合阿托伐他汀钙片治疗冠心病不稳定型心绞痛与常规剂量疗效基本相当,但安全性较好,值得临床推广。

Objective To investigate the efficacy and safety of low dose ticagrelor combined with atorvastatin calcium tablet in the treatment of coronary heart disease unstable angina pectoris.Methods Ninety patients with coronary heart disease unstable angina pectoris were selected and divided into the low dose group and conventional dose group according to the random number table method,45 cases in each group.On the basis of conventional treatment,the low dose group orally took the initial dose of 120 mg ticagrelor,then adjusted to 60 mg each time,twice a day;oral atorvastatin calcium tablet 20 mg each time,once a day.On the basis of conventional treatment,the initial dose of ticagrelor in the conventional dose group was 180 mg,then the dose was adjusted to 90 mg each time,twice a day;the usage and dosage of atorvastatin calcium tablets was the same as that of the low dose group.Both groups were continuously treated for 12 weeks.The serum inflammatory factors[high sensitivity C-reactive protein(hs-CRP),interleukin(IL)-6 and tumor necrosis factor-α(TNF-α)],cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and interventricular septum thickness at the diastolic end(IVST)],myocardial enzyme profile and myocardial injury indexes[matrix metalloproteinase-9(MMP-9),tissue plasminogen activator inhibitor-1(tPAI-1),soluble intercellular adhesion molecular-1(sICAM-1),cardiac troponin I(cTnI)and N-terminal pro-brain natriuretic peptide(NT-proBNP)],clinical efficacy and occurrence rate of adverse reactions before treatment and in 12 weeks after treatment were compared between the two groups.Results After 12-week treatment,hs-CRP,IL-6 and TNF-α levels in 2 groups were decreased compared with those before treatment(P<0.05),but there was no statistically significant difference between the groups(P>0.05).After 12 weeks of treatment,LVEF in the two groups was increased compared with that before treatment,while LVEDD and IVST were decreased compared with those before treatment(P<0.05),but there was no statistical difference between the two groups(P>0.05).After 12-week treatment,the levels of MMP-9,tPAI-1,sICAM-1,cTnI and NT-proBNP in the two groups were decreased compared with those before treatment(P<0.05),but there was no statistically significant difference between groups(P>0.05).After 12-week treatment,the total effective rate had no statistical difference between the low dose group and conventional dose group(P>0.05),but the incidence rate of adverse reactions in the low dose group was lower than that in the conventional dose group(P<0.05).Conclusion The efficacy of low dose ticagrelor combined with atorvastatin calcium tablets in the treatment of coronary heart disease unstable angina pectoris is basically the same as that of conventional dose,but the safety is good,and it is worthy of clinical promotion.