替格瑞洛治疗冠状动脉严重钙化的急性冠状动脉综合征临床分析
|
摘要
目的探讨替格瑞洛抗血小板治疗冠状动脉严重钙化的急性冠状动脉综合征(acute coronary syndrome, ACS)的临床疗效和安全性。方法冠状动脉严重钙化行经皮冠状动脉介入手术的ACS患者98例,随机分为观察组和对照组各49例。在常规治疗基础上,观察组给予替格瑞洛180 mg负荷量后,按90 mg/次,2次/d口服;对照组给予氯吡格雷300 mg负荷量后,按75 mg/次,1次/d治疗;2组均同时应用阿司匹林100 mg,1次/d口服;治疗12个月,比较2组主要心血管不良事件发生率、血清C反应蛋白、氨基末端脑钠肽前体水平以及出血发生情况。结果治疗12个月后,观察组和对照组血清C反应蛋白[(1.98±0.38)、(2.92±0.45)mg/L]、氨基末端脑钠肽前体水平[(62.18±4.57)、(73.45±3.26)ng/L]均较治疗前[(3.19±0.86)、(3.26±0.92)mg/L,(152.32±2.39)、(151.12±2.86)ng/L]降低(P<0.05),且观察组低于对照组(P<0.05);观察组主要心血管不良事件发生率(6.12%)低于对照组(26.53%)(P<0.05),非严重出血事件发生率(14.29%)与对照组(20.41%)比较差异无统计学意义(P>0.05)。结论替格瑞洛抗血小板治疗冠状动脉严重钙化的ACS疗效确切,安全性好。
Objective To investigate the clinical effect and safety of ticagrelor antiplatelet therapy for acute coronary syndrome(ACS) caused by severe coronary calcification. Methods Ninety-eight patients with ACS caused by severe coronary calcification undergoing percutaneous coronary intervention were divided into observation group and control group, with 49 patients in each group. On the basis of conventional treatment, observation group was given oral administration of ticagrelor 180 mg of load, followed by 90 mg per time, twice a day, and control group was given oral administration of 300 mg of clopidogrel, followed by 75 mg per time, once a day. Meanwhile, both groups were orally administrated with aspirin 100 mg, once a day. After 12-month treatment, the incidence of major cardiovascular adverse events, serum C-reactive protein level, amino-terminal pro-brain natriuretic peptide level, and hemorrhage incidence were compared between two groups. Results The levels of serum C-reactive protein((1.98±0.38),(2.92±0.45) mg/L) and amino-terminal pro-brain natriuretic peptide((62.18±4.57),(73.45±3.26) ng/L) after 12-month treatment were significantly lower than those before treatment((3.19±0.86),(3.26±0.92) mg/L;(152.32±2.39),(151.12±2.86) ng/L) in observation group and control group(P<0.05), and lower in observation group than those in control group(P<0.05). The incidence of major cardiovascular adverse events was significantly lower in observation group(6.12 %) than that in control group(26.53%)(P<0.05), and there was no significant difference in the incidence of severe hemorrhage between two groups(14.29% vs. 20.41%)(P>0.05). Conclusion The antiplatelet therapy by ticagrelor is effective and safe for ACS caused by severe coronary artery calcification.
Objective To investigate the clinical effect and safety of ticagrelor antiplatelet therapy for acute coronary syndrome(ACS) caused by severe coronary calcification. Methods Ninety-eight patients with ACS caused by severe coronary calcification undergoing percutaneous coronary intervention were divided into observation group and control group, with 49 patients in each group. On the basis of conventional treatment, observation group was given oral administration of ticagrelor 180 mg of load, followed by 90 mg per time, twice a day, and control group was given oral administration of 300 mg of clopidogrel, followed by 75 mg per time, once a day. Meanwhile, both groups were orally administrated with aspirin 100 mg, once a day. After 12-month treatment, the incidence of major cardiovascular adverse events, serum C-reactive protein level, amino-terminal pro-brain natriuretic peptide level, and hemorrhage incidence were compared between two groups. Results The levels of serum C-reactive protein((1.98±0.38),(2.92±0.45) mg/L) and amino-terminal pro-brain natriuretic peptide((62.18±4.57),(73.45±3.26) ng/L) after 12-month treatment were significantly lower than those before treatment((3.19±0.86),(3.26±0.92) mg/L;(152.32±2.39),(151.12±2.86) ng/L) in observation group and control group(P<0.05), and lower in observation group than those in control group(P<0.05). The incidence of major cardiovascular adverse events was significantly lower in observation group(6.12 %) than that in control group(26.53%)(P<0.05), and there was no significant difference in the incidence of severe hemorrhage between two groups(14.29% vs. 20.41%)(P>0.05). Conclusion The antiplatelet therapy by ticagrelor is effective and safe for ACS caused by severe coronary artery calcification.
引文
[1] 刘亚缸,卢海波,宋航.替格瑞洛治疗急性冠脉综合征的临床应用与评价[J].中国药业,2015,24(11):127-128.
[2] HAMM C W,BASSAND J P,AGEWAU S,et al.ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)[J].Eur Heart J,2011,32(22):2999-3054.
[3] 贺红祥.氯吡格雷治疗急性冠脉综合征35例疗效观察[J].中外医学研究,2011,9(23):35-36.
[4] 唐发宽,林乐健,华宁,等.CYP2C19基因多态性与介入治疗后氯吡格雷药物疗效的相关性研究[J].中华老年心脑血管病杂志,2012,14(9):911-914.
[5] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南2016[J].中华心血管病杂志2016,44(5):382-400.
[6] 楼善杰,黄诚意,朱劲草,等.替格瑞洛治疗急性冠状动脉综合征疗效[J].中华实用诊断与治疗杂志,2015,29(1):90-92.
[7] LEVINE G N,BATES E R,BITTL J A,et al.2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease:a report of the American College of Cardiology/American Heart Association task force on clinical practice[J].J Thorac Cardiovasc Surg,2016,152(5):1243-1275.
[8] 苏华,陈琛,李宝亮.B-型钠尿肽和N-末端-B-型钠尿肽前体在疾病诊断和预后判断中应用价值[J].中国老年学杂志,2016,36(22):5750-5753.
[9] 刘靖.2013《美国心脏协会/美国心脏病学会/美国疾病控制与预防中心高血压控制有效路径的科学建议》解读与启示[J].中华高血压杂志,2013,21(12):1101-1104.
[10] 朱秋玲.生化标志物在急性冠脉综合征的研究进展[J].现代预防医学,2011,38(22):4735-4737.
[11] 宋柳全,黎晓亮,何国欢,等.替格瑞洛临床应用概述[J].中国药师,2018,21(7):1269-1274.
[12] MAHAFFEY K W,WOJDYLA D M,CARROLL K,et al.Ticagrelor compared with clopidogrel by geographic region in the Platelet Inhibition and Patient Outcomes (PLATO) trial[J].Circulation,2011,124(5):544-554.
[13] 马登峰,裴志强,李炳蔚,等.替格瑞洛对急性ST段抬高型心肌梗死并发缓慢性心律失常临床结果影响的随机对照研究[J].中华实用诊断与治疗杂志,2018,32(3):275-278.
[2] HAMM C W,BASSAND J P,AGEWAU S,et al.ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)[J].Eur Heart J,2011,32(22):2999-3054.
[3] 贺红祥.氯吡格雷治疗急性冠脉综合征35例疗效观察[J].中外医学研究,2011,9(23):35-36.
[4] 唐发宽,林乐健,华宁,等.CYP2C19基因多态性与介入治疗后氯吡格雷药物疗效的相关性研究[J].中华老年心脑血管病杂志,2012,14(9):911-914.
[5] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南2016[J].中华心血管病杂志2016,44(5):382-400.
[6] 楼善杰,黄诚意,朱劲草,等.替格瑞洛治疗急性冠状动脉综合征疗效[J].中华实用诊断与治疗杂志,2015,29(1):90-92.
[7] LEVINE G N,BATES E R,BITTL J A,et al.2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease:a report of the American College of Cardiology/American Heart Association task force on clinical practice[J].J Thorac Cardiovasc Surg,2016,152(5):1243-1275.
[8] 苏华,陈琛,李宝亮.B-型钠尿肽和N-末端-B-型钠尿肽前体在疾病诊断和预后判断中应用价值[J].中国老年学杂志,2016,36(22):5750-5753.
[9] 刘靖.2013《美国心脏协会/美国心脏病学会/美国疾病控制与预防中心高血压控制有效路径的科学建议》解读与启示[J].中华高血压杂志,2013,21(12):1101-1104.
[10] 朱秋玲.生化标志物在急性冠脉综合征的研究进展[J].现代预防医学,2011,38(22):4735-4737.
[11] 宋柳全,黎晓亮,何国欢,等.替格瑞洛临床应用概述[J].中国药师,2018,21(7):1269-1274.
[12] MAHAFFEY K W,WOJDYLA D M,CARROLL K,et al.Ticagrelor compared with clopidogrel by geographic region in the Platelet Inhibition and Patient Outcomes (PLATO) trial[J].Circulation,2011,124(5):544-554.
[13] 马登峰,裴志强,李炳蔚,等.替格瑞洛对急性ST段抬高型心肌梗死并发缓慢性心律失常临床结果影响的随机对照研究[J].中华实用诊断与治疗杂志,2018,32(3):275-278.