替格瑞洛与氯吡格雷在急性心肌梗死患者经皮冠状动脉介入治疗中有效性和安全性的对比研究

摘要

目的 比较替格瑞洛与氯吡格雷在急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)中的有效性和安全性.方法 选取2014年1月-2015年5月郑州市第一人民医院心内科收治的AMI患者203例,随机分为替格瑞洛组90例和氯吡格雷组113例.在常规治疗及PCI基础上,替格瑞洛组患者给予替格瑞洛治疗,氯吡格雷组患者给予氯吡格雷治疗;两组患者均规律服药12个月.比较两组患者PCI前和PCI后1、6、12个月血小板计数、血小板最大聚集率、尿酸、肌酐及治疗期间不良事件发生情况(包括胸闷、缺血事件、出血事件).结果 时间与方法在血小板计数、肌酐上无交互作用(P＞0.05);时间在血小板计数、肌酐上主效应不显著(P＞0.05);方法在血小板计数、肌酐上主效应不显著(P＞0.05).时间与方法在血小板最大聚集率、尿酸上存在交互作用(P＜0.05);时间在血小板最大聚集率、尿酸上主效应显著(P＜0.05);方法在血小板最大聚集率、尿酸上主效应显著(P＜0.05);PCI后1、6、12个月替格瑞洛组患者血小板最大聚集率低于氯吡格雷组,PCI后6、12个月替格瑞洛组患者尿酸高于氯吡格雷组(P＜0.05).替格瑞洛组患者治疗期间胸闷、出血事件发生率高于氯吡格雷组,缺血事件发生率低于氯吡格雷组(P＜0.05).结论 与氯吡格雷相比,替格瑞洛能更好地抑制AMI患者PCI后血小板聚集,但高尿酸血症、胸闷、出血发生风险较高,应加以重视.%Objective To compare the effectiveness and safety in acute myocardial infarction patients undergoing PCI between ticagrelor and clopidogrel.Methods From January 2014 to May 2015,a total of 203 patients with acute myocardial infarction were selected in the Department of Cardiology,the First People's Hospital of Zhengzhou,and they were randomly divided into A group (n =90) and B group (n =113).Based on conventional treatment and PCI,patients of A group received ticagrelor,while patients of B group received clopidogrel;both groups continuously regularly taking the drugs for 12 months.PLT,MPAR,UA and Cr before PCI,after 1 month,6 months and 12 months of PCI,incidence of adverse events (including chest distress,ischemic events and bleeding events) during the treatment were compared between the two groups.Results No interaction was found between time and method in PLT or Cr (P ＞ 0.05);main effects of time and method were not significant in PLT or Cr (P ＞ 0.05).There was interaction between time and method in MPAR and UA (P ＜ 0.05);main effects of time and method were significant in MPAR and UA (P ＜0.05);after 1 month,6 months and 12 months of PCI,MPAR of A group was statistically significantly lower than that of B group,respectively (P ＜ 0.05);after 6 months and 12 months of PCI,UA of A group was statistically significantly higher than that of B group (P ＜ 0.05).During the treatment,incidence of chest distress and bleeding events of A group was statistically significantly higher than that of B group,while incidence of ischemic events of A group was statistically significantly lower than that of B group (P ＜ O.05).Conclusion Compared with clopidogrel,ticagrelor can more effectively inhibit the platelet aggregation in acute myocardial infarction patients undergoing PCI,but the risk of hyperuricemia,chest distress and bleeding events are relatively higher,which should pay more attentions to.