老年急性非ST段抬高心肌梗死合并糖尿病患者应用替罗非班的有效性和安全性

摘要

目的 评价血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班在老年非ST段抬高心肌梗死(NSTEMI)合并糖尿病患者中安全性和有效性.方法 随机将168例NSTEMI合并糖尿病的高危患者分为替罗非班组(80例)和常规治疗组(88例).比较2组患者PCI术后TIMI血流分级及B型钠尿肽(BNP)水平,观察术后7d及30 d的LVEF,左心室舒张末内径(LVEDD)和左心室收缩末内径(LVESD)的变化；术后30 d内主要不良心脏事件及出血发生率.结果 2组TIMI血流分级(计帧法)比较,替罗非班组优于常规治疗组[(34.2±5.9)帧vs (38.9±8.1)帧,P=0.014].替罗非班组7d及30 d的BNP水平明显低于常规治疗组[(237±192)ng/L vs (282±210)ng/L,P=0.034;(172±85)ng/L vs (218±105)ng/L,P=0.017].替罗非班组术后7d的LVEF显著高于常规治疗组(P=0.026).2组术后30 d的LVEF、LVEDD、LVESD比较,差异有统计学意义(P=0.037,P=0.021,P=0.028);替罗非班组24 h及30 d的不良心脏事件发生率明显低于常规治疗组；2组术后出血比较差异无统计学意义.结论 老年高危NSTEMI合并糖尿病患者应用替罗非班治疗是安全和有效的,疗效优于常规治疗,并未增加出血事件.%Objective To assess the safety and efficacy of tirofiban (a platelet membrane glucoprotein receptor Ⅱ b/Ⅲ a antagonist) in treatment of elderly acute non-ST elevation myocardial infarction (NSTEMI) patients with DM.Methods One hundred and sixty-eight elderly NSTEMI patients with DM were randomly divided into tirofiban treatment group (n=80) and routine therapy group (n=88).The TIMI grade and serum BNP level were compared between the two groups after PCI.The LVEDD,LVESD and LVEF were measured on days 7 and 30 after PCI.The incidence of major adverse cardiovascular events (MACE) and bleeding was recorded on day 30 after PCI.Results The TIMI grade was higher in tirofiban treatment group than in routine therapy group (34.2±5.9 vs 38.9±8.1,P=0.014).The serum BNP level was significantly lower in tirofiban treatment group than in routine therapy group on days 7 and 30 after PCI (237±192 ng/L vs 282± 210 ng/L,P=0.034; 172±85 ng/L vs 218±105 ng/L,P=0.017).The LVEDD was significantly higher in tirofiban treatment group than in routine therapy group (P=0.026).The LVESD and LVEF were significantly higher in the two groups on day 30 after PCI (P=0.037,P=0.021,P=0.028).The incidence of MACE was significantly lower in tirofiban treatment group than in routine therapy group.No significant difference was found in bleeding between the two groups.Conclusion Tirofiban is safe and effective in treatment of elderly NSTEMI patients with DM with a better effect than conventional therapy and does not increase the incidence of bleeding.