不同剂量氯吡格雷与替罗非班联用治疗急性心肌梗死临床研究

摘要

Objective To investigate the therapeutic effect and safety of different dose clopidogrel com-bined with tirofiban for acute myocardial infarction for providing evidence of dose selection. Methods 180 patients with acute myocardial infarction in Cardiology Department of 2nd people′s hospital in Boxing County in the period from May 2010 to January 2012 were randomly assigned small dose group (90 patients) with clopidogrel for 350 mg combined with tirofiban and large dose group (90 patients) with clopidogrel for 600 mg combined with tirofiban;and the sCD40 L and PDGF-BB before and after treatment,decline degree of ST segment,number of ischemia lead and adverse cardiac events were assessed in both groups. Results There was no significant difference in the sCD40 L and PDGF-BB,decline degree of ST segment and number of is-chemialeadbeforetreatmentbetween2groups(P>0.05).ThesCD40LandPDGF-BB,declinedegreeof ST segment and number of ischemia lead of both groups after treatment were significantly lower than before treatment(P<0. 05);and the related indicators of acute myocardial infarction of large dose group were sig-nificantly lower than small dose group[(150.3 ±26.9) μg/L vs (194.5 ±33.4) μg/L,(2071.7 ±577. 8) μg/L vs (2564.2 ±623.6) μg/L,(0.33 ±0.09) mm vs (0.65 ±0.14) mm,(1.74 ±0.48)one vs (2.86±0.87)one].Therecurrentrateofanginaandmyocardialinfarctionandmortalityoflargedosegroup were significantly lower than small dose group(8. 9% vs 23. 3%,1. 1% vs 11. 1%,1. 1% vs 8. 8%)(P<0. 05). Conclusion Compared with clopidogrel for conventional dose,clopidogrel for large dose combined with tirofiban on acute myocardial infarction can efficiently improve myocardial ischemia and reducing the risk of adverse cardiac events.%目的：探讨不同剂量氯吡格雷与替罗非班联用治疗急性心肌梗死的临床效果,为临床治疗剂量选择提供依据。方法选取博兴县第二人民医院心内科2010年5月至2012年1月收治急性心肌梗死患者180例,采用随机数字表法分为小剂量组和大剂量组,各90例。其中小剂量组患者采用氯吡格雷350 mg+替罗非班联合治疗；大剂量组患者采用氯吡格雷600 mg+替罗非班联合治疗。比较两组患者治疗前后血浆可溶性CD40配体(sCD40L)、血小板源性生长因子-BB(PDGF-BB)指标, ST段下降幅度,缺血导联个数及不良心脏事件发生情况。结果治疗前,小剂量组和大剂量组患者血浆sCD40L、PDGF-BB水平,ST段下降幅度及缺血导联个数比较差异无统计学意义(P>0.05)；治疗后,两组患者血浆sCD40 L、PDGF-BB水平,ST段下降幅度及缺血导联个数较治疗前均显著降低,且大剂量组患者治疗后上述各指标均显著低于小剂量组[(150.3±26.9)μg/L vs (194.5±33.4)μg/L,(2071.7±577.8)μg/L vs (2564.2±623.6)μg/L,(0.33±0.09) mm vs (0.65±0.14) mm,(1.74±0.48)个 vs(2.86±0.87)个],差异均有统计学意义(P<0.05)；同时大剂量组患者心绞痛再发、心肌梗死再发及病死率均低于小剂量组(8.9% vs 23.3%,1.1% vs 11.1%,1.1% vs 8.8%),组间比较差异有统计学意义(P<0.05)。结论大剂量氯吡格雷与替罗非班联用治疗急性心肌梗死相较于常规剂量可有效改善心肌缺血,减少不良心脏事件发生风险。