替格瑞洛与氯吡格雷治疗急性STEMI合并糖尿病患者疗效观察

Efficacy of ticagrelor and clopidogrel in the treatment of patients with acute ST elevation myocardial infarction complicated with diabetes mellitus

目的比较替格瑞洛与氯吡格雷治疗急性ST段抬高型心肌梗死(STEMI)合并糖尿病患者的临床疗效。方法采用回顾性分析的方法,选择我院2013年1月至2014年2月期间收治的行急诊经皮冠状动脉介入(PCI)且接受替格瑞洛联合阿司匹林治疗的157例急性STEMI合并糖尿病患者作为观察组;选择我院2012年1月至2013年1月期间收治的行急诊PCI术后接受氯吡格雷联合阿司匹林治疗的150例急性STEMI合并糖尿病患者作为对照组,比较两组患者治疗前后的血小板相关指标、主要不良心血管事件、心绞痛、再发心梗的累积发生率,以及治疗后不同时间段内主要安全重点事件的累积发生率。结果两组患者的临床一般资料比较差异均无统计学意义(P>0.05);治疗1周后,对照组与观察组的血小板聚集率分别为(58.23±4.21)%和(55.26±3.91)%,均较治疗前明显下降,且观察组明显低于对照组(P<0.05);治疗1周后,对照组与实验组患者的血小板计数分别为(187.63±23.92)×109/L和(220.76±20.82)×109/L,均较治疗前明显上升,且观察组明显高于对照组(P<0.05);治疗1周后,对照组和观察组患者的主要不良心血管事件发生率分别为2.7%(4/150)和0(0/157),观察组明显低于对照组(P<0.05);治疗1周后,对照组和观察组患者的总体出血累积发生率分别为0(0/150)和1.9%(3/157),观察组明显高于对照组(P<0.05),但致命出血累计发生率两组比较差异无统计学意义(P>0.05)。结论急性STEMI合并糖尿病患者应用替格瑞洛治疗较氯吡格雷能够发挥更好的抗血小板聚集作用,且能减少术后不良心血管事件发生率,降低术后致命出血累积发生率,具有较好的治疗效果,值得临床推广应用。

Objective To compare the clinical efficacy of ticagrelor and clopidogrel in the treatment of patients with acute ST elevation myocardial infarction(STEMI) complicated with diabetes mellitus. Methods A retrospective analysis method was used. A total of 157 patients with acute STEMI complicated with diabetes mellitus who underwent emergency percutaneous coronary intervention(PCI) and received ticagrelor combined with aspirin therapy in our hospital from January 2013 to February 2014 were selected as the observation group. Another 150 patients with acute STEMI complicated with diabetes mellitus who were treated with clopidogrel combined with aspirin after PCI in our hospital from January 2012 to January 2013 were enrolled as the control group. The platelet related indicators, major adverse cardiovascular events, angina pectoris, the cumulative incidence of myocardial infarction before and after treatment between the two groups were compared, as well as the cumulative incidence of major safety key events in the different time periods after treatment. Results General clinical data between two groups showed no statistically significance(P>0.05). After 1 week of treatment, the platelet aggregation rate of the control group and the observation group were(58.23±4.21)% and(55.26±3.91)%, respectively, which were significantly decreased compared with those before treatment, and were significantly lower in the observation group than the control group(P<0.05). After 1 week of treatment,the platelet count of the control group(187.63±23.92)×109/L and the observation group(220.76±20.82)×109/L were significantly increased compared with before treatment, and the level in observation group was significantly higher than that in the control group(P<0.05). After 1 week of treatment, the incidence of major adverse cardiovascular events in control group(2.7%, 4/150) was significantly higher than that in the observation group of(0, 0/157), P<0.05. After 1week of treatment, the cumulative incidence of bleeding in control group(0, 0/150) was significantly lower than that in observation group(1.9%, 3/157), P<0.05. But there was no significant difference in the cumulative incidence of fatal bleeding between the two groups(P>0.05). Conclusion Ticagrelor in the treatment of patients with acute STEMI complicated with diabetes mellitus can exert a better anti-platelet aggregation effect than clopidogrel, which can reduce the incidence of postoperative adverse cardiovascular events, reduce the cumulative incidence of fatal bleeding, and has a good therapeutic effect. It is worthy of clinical popularization and application.