急性冠状动脉综合征合并糖尿病患者经皮冠状动脉介入术后替格瑞洛与氯吡格雷抗血小板疗效及预后研究

宋予苹 魏来 王文君

[摘要] 目的 探讨对ACS合并糖尿病患者在PCI后应用替格瑞洛和氯吡格雷进行抗血小板治疗的效果，并对患者预后情况进行分析。方法 随机选取2016年10月—2018年6月于该院就诊的ACS合并糖尿病患者150例，在进行PCI后，将其随机分为A组与B组，A组患者应用替格瑞洛进行抗血小板治疗，B组患者应用氯吡格雷。结果 A组AA抑制率（64.63±16.34）%，高于B组（47.61±15.73）%;A组ADP抑制率（57.62±16.22）%，高于B组（31.45±14.63%）;A组MA-ADP （33.89±17.43）%，低于B组（49.43±18.93）%，差异有统计学意义（t=6.499、10.376、5.230，P<0.05）。结论 替格瑞洛对于ACS合并糖尿病的PCI术后患者抗血小板作用优于氯吡格雷，且不良事件更少。

[关键词] 急性冠状动脉综合征;糖尿病;替格瑞洛;氯吡格雷;血小板

[Abstract] Objective To explore the effect of antiplatelet therapy with ticagrelor and clopidogrel after PCI in patients with ACS and diabetes， and to analyze the prognosis of patients. Methods Ramdomly selected 150 patients with ACS and diabetes who were treated in the hospital from October 2016 to June 2018 were randomly divided into group A and group B after PCI. Patients in group A were treated with ticagrelor for resistance Platelet therapy， clopidogrel was administered to patients in group B. Results The inhibition rate of AA in group A was （64.63± 16.34）%， which was higher than that of group B（47.61 ± 15.73）%; the inhibition rate of ADP in group A was （57.62 ± 16.22）%， which was higher than that of group B（31.45 ± 14.63）%; and the MA-ADP in group A was（ 33.89 ± 17.43）%， which was lower than （49.43 ± 18.93）% of group B， and the differences were statistically significant （t=6.499， 10.376， 5.230， P<0.05）. Conclusion Tigrelor has better antiplatelet effect and less adverse events in patients with ACS and diabetes after PCI.

[Key words] Acute coronary syndrome; Diabetes; Ticagrelor; Clopidogrel; Platelets

急性冠脈综合征（ACS）是临床最为常见的危急重症之一，目前经皮冠状动脉介入（PCI）治疗是迅速缓解病情、疗效明确、改善预后的常用方法[1]。国外有研究认为替格瑞洛替代氯吡格雷可降低心血管事件的发生率，但其抗血小板效果和具体降低风险的作用国内尚缺乏相关研究[2]。该研究随机选取2016年10月—2018年6月于该院就诊的ACS合并糖尿病患者150例，分组后分别应用氯吡格雷和替格瑞洛进行干预，探讨二者抗血小板的效果及预防不良事件发生的作用，现报道如下。

1  资料与方法

1.1  一般资料

随机选取于该院就诊的ACS合并糖尿病患者150例，均于该院进行PCI治疗。纳入标准：冠脉造影确诊为ACS，冠脉主要血管或分支中至少1条狭窄超过75%，符合介入指征;血糖高于正常，确诊糖尿病[3]。排除标准：血小板<100×109/L或>450×109/L;患有血液系统疾病或凝血功能障碍;6个月内出现过脑卒中;肝肾功能、心功能不全;开始研究前得知对该研究所应用药物有过敏或不良反应;患有恶性肿瘤[4]。……