氯吡格雷对高敏C反应蛋白水平不同的不稳定型心绞痛患者心脏不良事件的影响

摘要

目的 评价氯吡格雷对高敏C反应蛋白(hs-CRP)水平不同的不稳定型心绞痛患者心脏不良事件的影响.方法 将176例不稳定型心绞痛患者根据入院后所测hs-CRP水平分为2组,即A组(hs-CRP＜ 2.87 mg/L,86例),B组(hs-CRP≥2.87 mg/L,90例).再将A组完全随机分为A1组(对照组,42例)和A2组(氯吡格雷治疗组,44例)；B组亦完全随机分为B1组(对照组,44例)和B2组(氯吡格雷治疗组,46例).对照组给予阿司匹林等常规治疗,治疗组在阿司匹林等常规治疗的基础上给予氯吡格雷75 mg/d.随访1年,比较A1组与A2组、B1组与B2组主要心血管事件、心血管死亡、急性心肌梗死、靶血管重建、卒中的情况.结果 A1组与A2组主要心血管事件、心血管性死亡、急性心肌梗死、靶血管重建、卒中的发生率差异无统计学意义(P＞0.05)；B1组与B2组心血管性死亡、急性心肌梗死、靶血管重建、卒中发生率差异无统计学意义(P＞0.05),4组主要心血管事件发生率不同(A1、A2、B1、B2组分别为6、9、7、16例),差异有统计学意义(P＜0.05).结论 氯吡格雷可减少基线hs-CRP水平增高的不稳定型心绞痛患者1年内的主要心血管事件,而不能减少基线hs-CRP水平正常的不稳定型心绞痛患者1年内的主要心血管事件.%Objective To appraise clopidogrel's impact on adverse cardiac events of unstable angina patients with different levels of high-sensitivity C-reactive proteins(hs-CRP).Methods One hundred and seventy-six cases of unstable angina patients were divided into two groups according to the levels of hs-CRP:group A( hs-CRP ＜2.87 mg/L,86 cases),group B(hs-CRP≥2.87mg/L,90 cases).Group A were randomly divided into group A1(control group,42 cases) and group A2 (observation group,44 cases),and group B were divided into group B1 (control group,44 cases) and group B2( observation group,46 cases)at the same way.The patients of control groups adopted common treatment with aspirin etal,otherwise,the patients of observation groups were given clopidogrel 75 mg,qd besides common treatment.After a year,group A1's incidence rates of the main cardiovascular events、cardiovascular deaths、acute myocardial infarctions、target vessel re-establishments and strokes were compared with group A2 's respectively,and group B1 's compared with group B2's also.Results Incidence rates of group A1 and group A2 's main cardiovascular events、cardiovascular deaths、acute myocardial infarctions、target vessel re-establishments and strokes are alike respectively (P ＞ 0.05 ) ; incidence rates of group B1 and group B2 's cardiovascular deaths,acute myocardial infarctions、target vessel re-establishments and strokes did not reach statistical difference ( P ＞0.05 ),but their incidence rates of main cardiovascular events are different ( P ＜ 0.05 ).Conclusions Clopidogrel can reduce incidence rate of unstable angina patients' main cardiovascular events in a year who have elevated baseline level of hs-CRP,but can't reduce incidence rate of unstable angina patients' main cardiovascular events in a year who have normal base-line level of hs-CRP.