基于缺血和出血风险的稳定型冠心病抗栓治疗策略优化分析

Optimization of antithrombotic therapy strategy for stable coronary heart disease based on risks of ischemia and bleeding

目的探讨稳定型冠状动脉粥样硬化性心脏病(冠心病)患者的抗栓治疗,以提高抗栓治疗的安全性及有效性。方法前瞻性选取2019年1月至2022年10月于滁州市第一人民医院心内二科收治的162例高缺血风险、低出血风险的稳定型冠心病患者作为研究对象,患者通过随机数表法分为对照组和观察组,每组各81例。对照组采用双抗血小板方案(阿司匹林联合氯吡格雷)治疗,观察组采取双通道抗栓方案(利伐沙班联合阿司匹林)治疗,两组均治疗6个月。比较两组患者治疗前后血小板聚集率、临床相关指标[血小板表面α-颗粒膜糖蛋白(CO62P)、内皮素1(ET-1)、一氧化氮(NO)水平、冠状动脉血流储备分数(FFR)、微循环阻力指数(IMR)]以及治疗期间主要不良心血管事件(MACE)和出血事件发生情况。结果治疗6个月后,两组患者血小板聚集率均降低,观察组较对照组下降更低(P<0.05)。与治疗前比较,两组患者治疗6个月后CO62P、ET-1、IMR水平均降低,NO、FFR水平均升高,且观察组CO62P、ET-1、IMR水平低于对照组,NO、FFR水平高于对照组(P<0.05)。观察组患者治疗期间MACE总发生率低于对照组(P<0.05)。相比于对照组,观察组治疗期间出血发生率稍高,差异无统计学意义(P>0.05)。结论双通道抗栓治疗可改善高缺血风险、低出血风险稳定型冠心病患者血小板聚集率,改善临床相关指标,降低MACE发生风险,且不增加出血事件发生风险。

Objective To investigate the antithrombotic therapy strategy for stable coronary heart disease(CHD),and to improve the safety and effectiveness.Methods The patients with stable CHD(n=162,with high ischemia risk and low bleeding risk)were prospectively chosen from the Second Department of Cardiology in the First People's Hospital of Chuzhou City from Jan.2019 to Oct.2022.The patients were divided,by using random digital table,into control group and observation group(each n=81).The control group was given double antiplatelet therapy(aspirin combined with clopidogrel),and observation group was given double channel antithrombotic therapy(rivaroxaban combined with aspirin)for 6 months.The levels of platelet aggregation rate(PAG)and relative clinical indexes[platelet surfaceα-granule membrane glycoprotein(CO62P),endothelin-1(ET-1),nitric oxide(NO),fractional flow reserve(FFR),index of microcirculatory resistance(IMR)]and occurrence of major adverse cardiovascular events(MACE)and bleeding events during treatment were compared between 2 groups.Results After treatment for 6 months,PAG decreased in 2 groups,and PAG was lower in observation group than that in control group(P<0.05).After treatment for 6 months,the levels of CO62P,ET-1 and IMR decreased,and levels of NO and FFR increased in 2 groups,while levels of CO62P,ET-1 and IMR were lower,and levels of NO and FFR were higher in observation group than those in control group(P<0.05).The total incidence of MACE was lower in observation group than that in control group(P<0.05).The incidence of bleeding events was slightly higher in observation group than that in control group during treatment(P>0.05).Conclusion The double channel antithrombotic therapy can reduce PAG,relative clinical indexes and MACE risk,and does not increase bleeding risk in patients with stable CHD(with high ischemia risk and low bleeding risk).