硫酸氢氯吡格雷改善慢性稳定型心绞痛患者阿司匹林抵抗的临床研究

摘要

目的 研究硫酸氢氯吡格雷(泰嘉)对慢性稳定型心绞痛阿司匹林抵抗患者的治疗价值.方法 610例慢性稳定型心绞痛患者依照血小板聚集率分为阿司匹林敏感(AS)者和阿司匹林抵抗(AR)者,将138例AR者随机分为阿司匹林治疗组(AR-A组)、泰嘉治疗组和泰嘉联合阿司匹林治疗组(AR-C组),472例AS者中随机选取40例设为对照组.4组患者给予严格的药物治疗后随访1年,观察4组患者在治疗前后的血小板聚集率变化,以及治疗后缺血性心脑血管病的发生率和出血性事件的发生率.治疗1月后行12导联24 h动态心电图检查,计算24 h内缺血型ST段变化的次数、持续时间、心肌缺血总负荷.结果 泰嘉可以有效地降低慢性稳定型心绞痛AR患者的血小板聚集率(P<0.01);较少发生缺血性心脑血管事件(P<0.01),且不增加出血事件的发生(P>0.05) .对存在AR的慢性稳定型心绞痛患者,单用泰嘉和联合服用阿司匹林治疗,其缺血性ST段变化的次数、持续时间及心肌缺血总负荷明显低于单用阿司匹林治疗(P<0.05或 P<0.01).结论 泰嘉与阿司匹林联合使用不仅安全,而且能提高慢性稳定型心绞痛AR患者的临床疗效.%Objective To evaluate therapeutic value of Talcom on aspirin resistance in chronic stable angina.Methods Six hundreds and ten patient (pts) with chronic stable angina was divided into aspirin sensitive group (AS) and aspirin resistant group (AR) based on platelet aggregation fraction.One hundred and thirty-eight pts in AR group were sub-divided into AR-A group,Talcom group,and combined (AR-C) group randomly.Forty pts of in AS group were as control group.Pts were followed-up for one year after medication to observe platelet aggregation fraction,incidence of ischemic cardiovascular or cerebrovascular disease,and incidence of hemorrhagic event.Results Platelet aggregation fraction in Talcom group were reduced significantly(P<0.01) without increasing incidence of hemorrhagic event (P>0.05).Frequency of ischemic ST segment variation,persistence time,overall load of myocardial ischemia in Talcom group and AR-C group were less than that in AR-A group (P<0.05 or P<0.01).Conclusion Talcom with aspirin was safe,and could elevate clinical therapeutic effect in pts with chronic stable angina.