盐酸替罗非班对非ST段抬高急性冠脉综合征患者血小板聚集率、sCD40L水平及预后的影响

摘要

目的 观察盐酸替罗非班对非ST段抬高急性冠脉综合征(NSTEACS)患者血小板聚集率、sCD40L水平及预后的影响.方法 入选60例NSTE-ACS患者,随机分为常规治疗组(n=30)和替罗非班组(n=30).常规治疗组给予抗凝、抗血小板、调脂等常规药物治疗;替罗非班组在常规治疗的基础上,联合应用盐酸替罗非班持续治疗48 h.在应用替罗非班治疗前、后,分别测定血浆ADP诱导的血小板聚集率、血清sCD40L水平.同时记录两组患者30 d随访期间发生心血管事件情况.结果 用药前基线水平时常规治疗组、替罗非班组血小板聚集率分别为(49.88±11.81)%及(47.73±10.31)%,两组差异无统计学意义(P＞0.05).常规治疗及应用替罗非班48 h后,两组血小板聚集率均有下降,分别为(36.27±15.89)%及(9.04±6.16)%,与基线水平相比均有统计学差异(P＜0.05~0.01),替罗非班组血小板聚集率下降幅度显著高于常规治疗组.常规治疗组、替罗非班组sCD40L基线水平分别为(1.63±1.04) ng/mL及(1.69±1.16) ng/mL,两组间差异无统计学意义(P＞0.05).常规治疗及应用替罗非班48 h后,两组sCD40L均有下降,分别为(1.27±1.14) ng/mL及(0.54±0.48) ng/mL,但与基线水平相比,仅替罗非班组具有显著统计学差异(P＜0.01).两组患者出血不良反应以及30 d再发心血管事件没有统计学差异.结论 NSTE-ACS患者中应用盐酸替罗非班可产生更迅速、有效的抑制血小板聚集及降低sCD40L水平的作用.%Objective To observe the influences of tirofiban hydrochloride on platelet aggregation rate, level of soluble CD40 ligand ( sCD40L ) and prognosis in patients with non-ST-elevation acute coronary syndrome ( NSTE-ACS ). Methods The patients with NSTE-ACS ( n = 60 ) were randomly divided into routine group ( n = 30 ) and tirofiban group ( n =30 ). The routine group was treated with routine medications with actions of anticoagulation, antiplate-let and regulating lipid,and tirofiban group,with tirofiban hydrochloride besides routine medications for 48 hours. The platelet aggregation rate induced by plasma ADP and level of serum sCD40L were detected before and after tirofiban administration. The recurrent cardiovascular events were recorded during 30-day follow-up in two groups. Results Before the treatment and at datum level, platelet aggregation rate was, respectively,( 49. 88 ± 11. 81 )% and ( 47. 73 ± 10.31)% in routine group and tirofiban group ( P > 0.05 ). After routine and tirofiban treatment for 48 hours, platelet aggregation rate decreased in two groups being ( 36. 27 ± 15. 89 )% and ( 9. 04 ± 6. 16 )% respectively, and was different statistically compared with datum level ( P <0.05 ,P <0. 01 ). The decrease amplitude of platelet aggregation rate was significantly higher in tirofiban group than that in routine group. The datum level of sCD40L was, respectively, ( 1. 63 ± 1.04 ) ng/mL and (1. 69 ±1.16) ng/mL in routine group and tirofiban group ( P > 0. 05 ). After routine and tirofiban treatment for 48 hours, sCD40L level decreased in two groups being ( 1. 27 ± 1. 14 ) ng/mL and ( 0. 54 ± 0.48 ) ng/mL respectively,but there was significant and statistical difference only in tirofiban group compared with the datum level ( P<0.01 ). There were no differences in bleeding adverse reactions and 30-day recurrent cardiovascular events between two groups. Conclusion The administration of tirofiban in patients with NSTE-ACS will play more rapid and effective role in inhibiting platelet aggregation and decreasing sCD40L level.