阿司匹林和吲哚布芬对2型糖尿病合并急性冠状动脉综合征患者经皮冠状动脉介入术后疗效比较

Effect of combination of clopidogrel,daglizin and indolbuprofen on shortterm prognosis of T2DM patients with ACS after PCI

目的 探讨吲哚布芬与氯吡格雷、达格列净联合应用对2型糖尿病(T2DM)合并急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后疗效的影响。方法 纳入2020年6月-2022年12月接受PCI治疗的96例T2DM合并ACS患者,按随机数表法分为对照组(48例)与研究组(48例)。对照组术后采用阿司匹林、氯吡格雷和达格列净治疗;研究组术后采用吲哚布芬、氯吡格雷和达格列净治疗。比较2组术前和术后12周的血糖水平、血小板相关指标、凝血功能和炎性因子水平;比较2组PCI术前、术后即刻和术后12周冠状动脉管腔狭窄程度;统计2组术后6个月内的不良事件发生情况。结果 术后12周,2组空腹血糖、餐后2 h血糖和糖化血红蛋白均低于术前(P<0.05),但组间比较差异无统计学意义(P>0.05);术后12周,2组血小板计数和血小板聚集率均低于术前(P<0.05),且研究组低于对照组(P<0.05);2组治疗凝血酶原时间(PT)、凝血酶时间(TT)和活化部分凝血活酶时间(APTT)均高于术前,纤维蛋白原(FIB)低于术前(P<0.05),且研究组PT、TT和APTT高于对照组,FIB低于对照组(P<0.05);2组白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和超敏C反应蛋白(hs-CRP)水平均低于术前,且研究组低于对照组(P<0.05)。术后12周研究组冠状动脉管腔狭窄程度低于对照组(P<0.05);术后6个月2组不良事件发生率比较差异无统计学意义(P>0.05)。结论 与阿司匹林比较,吲哚布芬联合氯吡格雷和达格列净对T2DM合并ACS行PCI术的患者术后疗效更好,吲哚布芬联合氯吡格雷和达格列净有更好的抑制血小板活化和聚集及抗凝血的功能,能够显著降低血糖和炎性因子水平,具有较好的安全性,值得临床推广。

AIM To investigate the short-term prognosis of patients with type 2 diabetes mellitus(T2DM) complicated with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI) with clopidogrel, dapagliflozin and indobufen. METHODS A total of 96 patients with T2DM complicated with ACS who underwent PCI in the hospital from June 2020 to December 2022 were randomly divided into control group(48 patients) and study group(48 patients). The control group was treated with aspirin, clopidogrel and dapagliflozin after surgery, and the study group was treated with indobufen, clopidogrel and dapagliflozin after surgery. The blood sugar level, platelet parameters, coagulation function and inflammatory factors were observed before and after treatment for 12 weeks, and the degree of lumen stenosis before and immediately after PCI was compared between 2 groups, and the incidence of adverse events in the six-month follow-up of 2 groups was counted. RESULTS After 12 weeks of treatment, the fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin in 2 groups were lower than those before treatment(P< 0.05), but there was no significant difference between 2 groups(P > 0.05). After 12 weeks of treatment, the platelet count and platelet aggregation rate in both groups were lower than before treatment, and the study group was lower than the control group(P< 0.05). After 12weeks of treatment, the prothrombin time(PT), thrombin time(TT) and activated partial thromboplastin time(APTT) in both groups were longer than those before treatment, and the fibrinogen(FIB) was lower than that before treatment, and the change range in the study group was higher than that in the control group(P< 0.05). After 12 weeks of treatment, the levels of interleukin-1β(IL-1β), interleukin-6(IL-6) and high-sensitivity C-reactive protein(hs-CRP) in both groups were lower than those before treatment, and the levels in the study group were lower than those in the control group(P< 0.05).At 12th week after operation, the degree of lumen stenosis in the study group was lower than that in the control group(P< 0.05). Within 6 months of follow-up, there was no significant difference in the incidence of adverse events between 2 groups(P > 0.05). CONCLUSION Compared with aspirin, the combined application of clopidogrel, dapagliflozin and indobufen in patients with T2DM complicated with ACS after PCI has better functions in inhibiting platelet activation and aggregation, and anticoagulation, can significantly reduce blood sugar and inflammatory factor levels, has shown good safety profiles, making it suitable for clinical promotion.