替格瑞洛片联合阿司匹林片用于经皮冠状动脉介入术的急性ST段抬高型心肌梗死患者的临床研究

详细信息    查看全文 | 推荐本文 |

英文篇名：Clinical trial of ticagrelor tablets combined with aspirin tablets in the treatment of patients with ST-segment elevation myocardial infarction undergoing percutaneous transluminal coronary intervention 作者：董艳丽 ; 董淑娟 英文作者：DONG Yan-li;DONG Shu-juan;Department of Cardiovascular Medicine,The Second People's Hospital of Zhengzhou;Department of Cardiology,Henan Province People ' s Hospital; 关键词：替格瑞洛片 ; 氯吡格雷片 ; 阿司匹林片 ; 急性ST段抬高型心肌梗死 ; 安全性评价 英文关键词：ticagrelor tablet;;clopidogrel tablet;;aspirin tablet;;acute ST-segment elevation myocardial infarction;;safety evaluation 中文刊名：GLYZ 英文刊名：The Chinese Journal of Clinical Pharmacology 机构：郑州市第二人民医院心血管内科;河南省人民医院心血管内科; 出版日期：2019-04-17 出版单位：中国临床药理学杂志 年：2019 期：v.35;No.285 基金：河南省医学科技攻关计划基金资助项目(201303118) 语种：中文; 页：GLYZ201907004 页数：3 CN：07 ISSN：11-2220/R 分类号：16-18

摘要

目的观察替格瑞洛片联合阿司匹林片用于经皮冠状动脉介入术(PCI)治疗急性ST段抬高型心肌梗死(STEMI)患者的临床疗效及安全性。方法将426例PCI治疗急性STEMI患者随机分为对照组213例和试验组213例。对照组在急诊PCI术前口服氯吡格雷负荷剂量600 mg和阿司匹林300 mg,术后口服氯吡格雷每次75 mg,qd和阿司匹林每次100 mg,qd;试验组在急诊PCI术前口服替格瑞洛负荷剂量180 mg和阿司匹林300 mg,术后口服替格瑞洛每次90mg,bid和阿司匹林每次100 mg,qd。2组患者均治疗30 d。比较2组患者的红细胞分布宽度(RDW)、中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR),以及药物不良反应的发生情况。结果 PCI术后30 d,试验组和对照组的RDW值分别为(14. 85±0. 95)%和(11. 48±1. 43)%,NLR值分别为(2. 98±0. 98)%和(2. 09±1. 68)%,PLR值分别为(120. 34±13. 88)%和(131. 36±12. 96)%,差异均有统计学意义(均P <0. 05)。试验组的药物不良反应主要有眩晕、胃肠道出血和血清肌酸酐上升,对照组的药物不良反应主要有腹泻、胃肠道出血、头痛和恶心呕吐。试验组和对照组的总药物不良反应发生率分别为5. 16%和9. 86%,差异有统计学意义(P <0. 05)。结论替格瑞洛片联合阿司匹林片用于PCI治疗急性STEMI的临床疗效确切,且安全性较好。
        Objective To observe the clinical efficacy and safety of ticagrelor tablets combined with aspirin tablets in patients with ST-segment elevation myocardial infarction( STEMI) treated with percutaneous coronary intervention( PCI). Methods A total of 426 patients with STEMI treated with PCI were randomly divided into control and treatment groups with 213 cases per group. Control group was orally given the loading dose of clopidogrel 600 mg + aspirin 300 mg before PCI,followed by oral clopidogrel 75 mg per time,qd + aspirin 100 mg per time,qd,after operation. Treatment group was given orally ticagrelor with the loading dose of 180 mg + aspirin 300 mg before PCI,followed ticagrelor 90 mg per time orally,bid + aspirin 100 mg per time,qd,after operation.Two groups were treated for 30 days. The red blood cell distribution width( RDW),neutrophil/lymphocyte ratio( NLR),platelet/lymphocyte ratio( PLR) and adverse drug reactions were compared between two groups. Results After PCI 30 days,the main indexes of treatment and control groups were compared: RDW were( 14. 85 ± 0. 95) % and( 11. 48 ± 1. 43) %,NLR were( 2. 98 ± 0. 98) % and( 2. 09 ± 1. 68) %,PLR were( 120. 34 ± 13. 88) % and( 131. 36 ± 12. 96) %,the differences were statistically significant( all P < 0. 05). The adverse drug reactions of treatment group were dizziness,gastrointestinal bleeding and serum creatinine rise,which in control group were diarrhea,gastrointestinal bleeding,headache,nausea and vomiting. The total incidences of adverse drug reactions in the treatment and control groups were 5. 16% and9. 86% with significant difference( P < 0. 05). Conclusion Ticagrelor tablets combined with aspirin tablets have a definitive clinical efficacy and safety in the treatment of patients with STEMI treated with PCI.

引文

[1]EASTON J D,AUNES M,ALBERS G W,et al.Risk for major bleeding in patients receiving ticagrelor compared with aspirin after transient ischemic attack or acute ischemic stroke in the SOCRATESstudy(acute stroke or transient ischemic attack treated with aspirin or ticagrelor and patient outcomes)[J].Circulation,2017,136(10):907-916.
    [2]刘晓刚,胡立群,刘玉峰,等.替格瑞洛与氯吡格雷对急性非ST段抬高型心肌梗死患者经皮冠状动脉介入术后炎症因子的影响[J].中国临床药理学杂志,2016,32(9):789-791.
    [3]AMARENCO P,ALBERS G W,DENISON H,et al.Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin:a subgroup analysis of SOCRA-TES,a randomised,double-blind,controlled trial[J].Lancet Neurol,2017,16(4):301-310.
    [4]林彬,生娣.替格瑞洛联合阿司匹林治疗急性脑梗死的效果及安全性[J].中国医药,2016,11(4):524-527.
    [5]中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
    [6]朱勇,张美春,高孟秋,等.替格瑞洛与氯吡格雷对冠心病患者冠状动脉介入术后炎症因子的影响[J].中国临床药理学杂志,2016,32(14):1257-1260.
    [7]贾珠银,杨建敏.替格瑞洛联合阿司匹林治疗急性冠状动脉综合征的临床研究[J].中国临床药理学杂志,2016,32(14):1254-1256.
    [8]毛霄鹏,严语.替格瑞洛与氯吡格雷对经皮冠状动脉介入术治疗的ST段抬高型心肌梗死患者的临床疗效[J].中国临床药理学杂志,2016,32(9):786-788.
    [9]POUWELS X,WOLFF R,RAMAEKERS B,et al.Ticagrelor for secondary prevention of atherothrombotic events after myocardial infarction:An evidence review group perspective of a nice single technology appraisal[J].Pharmacoeconomics,2018,36(5):533-543.