吲哚布芬联合氯吡格雷治疗老年冠心病PCI术后患者的临床研究

Clinical trial of indobufen combined with clopidogrel in the treatment of elderly patients with coronary heart disease after PCI

目的观察吲哚布芬片联合氯吡格雷片治疗对老年冠心病经皮冠状动脉介入治疗(PCI)术后患者血清心肌损伤指标水平和主要不良心血管事件(MACE)发生率的影响。方法将老年冠心病PCI术后患者按队列法分为试验组[氯吡格雷75 mg(qd)联合吲哚布芬200 mg(qd)]与对照组[氯吡格雷75 mg(qd)联合阿司匹林100 mg(qd)]。2组患者均治疗3个月。比较2组患者的临床疗效、血清心肌损伤指标[氨基末端B型钠尿肽原(NT-proBNP)、心肌肌钙蛋白(cTnⅠ)]、凝血-纤溶指标[纤维蛋白原(FIB)、凝血酶原时间(PT)、抗凝血酶Ⅲ(AT-Ⅲ)]、血小板功能[血小板分布宽度(PDW)]。比较2组患者术后6个月内出血事件和MACE的发生情况,并进行安全性评价。结果对照组和试验组均入组32例。治疗后,试验组和对照组的总有效率分别为93.75%(30例/32例)和78.13%(25例/32例),在统计学上差异无统计学意义(P>0.05)。治疗后,试验组和对照组的NT-proBNP分别为(202.65±30.77)和(283.52±31.42)pg·mL^(-1),cTnⅠ分别为(0.06±0.01)和(0.12±0.03)ng·mL^(-1),FIB分别为(3.17±0.51)和(3.84±0.59)g·L^(-1),PT分别为(15.87±1.23)和(14.92±1.35)s,AT-Ⅲ分别为(138.95±14.18)%和(125.17±14.96)%,PDW分别为(17.04±2.04)%和(19.13±2.32)%,在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组的出血事件发生率分别为6.25%和15.63%,药物不良反应发生率分别为9.38%和15.63%,在统计学上差异均无统计学意义(均P>0.05)。试验组和对照组的PCI术后患者MACE总发生率分别为6.25%和25.00%,在统计学上差异有统计学意义(P<0.05)。结论吲哚布芬片联合氯吡格雷片治疗可以降低老年冠心病PCI术后患者的血清心肌损伤指标水平,改善凝血-纤溶系统功能,降低MACE发生率。

Objective To observe the effects of indobufen tablets combined with clopidogrel tablets on levels of serum myocardial injury indexes and incidence of major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods The elderly patients with coronary heart disease after PCI were divided into treatment group[clopidogrel 75 mg(qd)combined with indobufen 200 mg(qd)]and control group[clopidogrel 75 mg(qd)combined with aspirin 100 mg(qd)]according to cohort method.All patients were treated for 3 months.The total effective rate,serum myocardial injury indexes[N terminal pro B type natriuretic peptide(NT-proBNP),cardiac troponinⅠ(cTnⅠ)],coagulation-fibrinolysis indexes[fibrinogen(FIB),prothrombin time(PT),anti thrombinⅢ(AT-Ⅲ)]and platelet function indexes[platelet distribution width(PDW)]were compared between two groups.Occurrence of bleeding events and MACE within 6 months were compared between the two groups.The safety was evaluated.Results There were 32 cases in control group and 32 cases in treatment group.After treatment,the total effective rates in treatment group and control group were 93.75%(30 cases/32 cases)and 78.13%(25 cases/32 cases),without significant difference(P>0.05).After treatment,NT-proBNP levels in treatment group and control group were(202.65±30.77)and(283.52±31.42)pg·mL^(-1),cTnⅠlevels were(0.06±0.01)and(0.12±0.03)ng·mL^(-1),FIB levels were(3.17±0.51)and(3.84±0.59)g·L^(-1),PT were(15.87±1.23)and(14.92±1.35)s,AT-Ⅲlevels were(138.95±14.18)%and(125.17±14.96)%,PDW were(17.04±2.04)%and(19.13±2.32)%,the differences were statistically significant(all P<0.05).The incidences of bleeding events in treatment group and control group were 6.25%and 15.63%,adverse drug reactions were 9.38%and 15.63%,respectively,the differences of above indexes were statistically significant between two groups(all P>0.05).The total incidences of MACE in treatment group and control group were 6.25%and 25.00%,respectively(P<0.05).Conclusion Indobufen tablets combined with clopidogrel tablets can reduce levels of serum myocardial injury indexes in elderly patients with coronary heart disease after PCI,improve coagulation-fibrinolysis function and reduce the incidence of MACE.