替格瑞洛片联合左旋精氨酸注射剂治疗急性ST段抬高型心肌梗死的临床研究

Clinical trial of ticagrelor tablets combined with L-arginine injection in the treatment of acute ST-segment elevation myocardial infarction

目的观察替格瑞洛片联合左旋精氨酸注射剂治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效及安全性。方法将133例急性STEMI患者随机分为对照组57例和试验组76例。对照组于冠状动脉造影前15 min给予替格瑞洛180 mg,口服,术后第2天起每次90 mg,bid,口服,持续12个月;试验组在对照组治疗的基础上,予以左旋精氨酸每次200 mg,qd,静脉滴注,持续治疗10 d。比较2组患者的临床疗效,血小板聚集率和心功能,治疗后30 d内的心血管事件,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为92. 11%(70例/76例)和78. 95%(45例/57例),差异有统计学意义(P <0. 05)。治疗后,试验组和对照组的血小板聚集率分别为(37. 87±4. 47)%和(48. 91±7. 74)%,左心室射血分数分别为(47. 82±6. 61)%和(44. 28±3. 38)%,左心室收缩末期内径分别为(40. 75±4. 61)和(44. 56±6. 13) mm,左心室舒张末期内径分别为(44. 09±5. 11)和(50. 25±7. 72) mm,差异均有统计学意义(均P <0. 05)。试验组和对照组治疗后30 d内心血管事件的总发生率分别为3. 94%和15. 79%,差异有统计学意义(P <0. 05)。2组患者的药物不良反应主要有胃肠道反应和过敏反应,试验组和对照组的总药物不良反应发生率分别为9. 21%和7. 02%,差异无统计学意义(P> 0. 05)。结论替格瑞洛片联合左旋精氨酸注射剂治疗急性STEM的临床疗效确切,其能显著改善患者的心功能和短期预后,降低患者的心血管事件发生风险和血小板聚集率,且不增加药物不良反应的发生率。

Objective To observe the clinical efficacy and safety of ticagrelor tablets combined with L-arginine injection in the treatment of acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 133 cases of acute STEMI were randomly divided into control group(n=57 cases)and treatment group(n=76 cases).15 min before coronary angiography,control group was given ticagrelor 180 mg,orally,and adjusted to 90 mg per time,bid from the second day after operation for 12 months.Treatment group received L-arginine 200 mg per time,qd,intravenously for 10 days,on the basis of control group.The clinical efficacy,platelet aggregation rate and cardiac function,and cardiovascular events within 30 days after treatment and adverse drug reactions werecompared between two groups.Results After treatment,the total effective rates of treatment and control groups were92.11%(70 cases/76 cases)and 78.95%(45 cases/57 cases)with significant difference(P<0.05).After treatment,the main indexes of treatment and control groups were compared:platelet aggregation rates were(37.87±4.47)%and(48.91±7.74)%,left ventricular ejection fraction were(47.82±6.61)%and(44.28±3.38)%,left ventricular end-systolic diameter were(40.75±4.61)and(44.56±6.13)mm,left ventricular end-diastolic diameter were(44.09±5.11)and(50.25±7.72)mm,the differences were statistically significant(all P<0.05).Within 30 days after treatment,the total incidences of cardiovascular events of treatment and control groups were 3.94%and 15.79%with significant difference(P<0.05).The adverse drug reactions of two groups were gastrointestinal reactions and allergic reactions.The total incidences of adverse drug reactions in the treatment and control groups were 9.21%and 7.02%without significant difference(P>0.05).Conclusion Ticagrelor tablets combined with L-arginine injection have a definitive clinical efficacy in the treatment of acute STEM,which can significantly improve the cardiac function and short-term prognosis,reduce the risk of cardiovascular events and platelet aggregation rate,without increasing the incidence of adverse drug reactions.