目的 對(duì)比伴缺血性腦梗死史急性冠脈綜合征患者應(yīng)用替格瑞洛片和硫酸氫氯吡格雷片的臨床療效和安全性。方法 選取2014年5月-2015年3月在上海市普陀區(qū)中心醫(yī)院住院治療的伴缺血性腦梗死史的急性冠脈綜合征患者66例,隨機(jī)分為對(duì)照組(31例)和治療組(35例)。所有患者給予常規(guī)治療,未行經(jīng)皮冠脈介入(PCI)治療。對(duì)照組口服硫酸氫氯吡格雷片300 mg負(fù)荷劑量,維持劑量75 mg,1次/d。治療組口服替格瑞洛片180 mg負(fù)荷劑量,維持劑量90 mg,2次/d。兩組均連續(xù)治療30 d。觀察兩組的臨床療效,比較兩組給藥后7、30 d的主要心腦血管不良事件(MACCE)發(fā)生率、出血事件發(fā)生率和不良反應(yīng)發(fā)生率,并檢測(cè)患者血清白細(xì)胞介素6(IL-6)、高敏C反應(yīng)蛋白(hs-CRP)水平。結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為90.3%、97.1%,兩組總有效率比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療7、30 d后,兩組MACCE發(fā)生率、出血事件發(fā)生率比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),不良反應(yīng)發(fā)生率的差異無統(tǒng)計(jì)學(xué)意義。治療7、30 d后,兩組IL-6、hs-CRP水平較治療前顯著下降,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),且治療組這些觀察指標(biāo)的下降程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 替格瑞洛片治療伴缺血性腦梗死史的急性冠脈綜合征具有較好的臨床療效,能顯著降低MACCE發(fā)生率,抑制炎性因子水平,其效果優(yōu)于硫酸氫氯吡格雷片,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To compare the clinical curative and safety of Ticagrelor Tablets and Clopidogrel Hydrogen Sulfate Tablets in treatment of acute coronary syndrome with a history of ischemic stroke.Methods Patients (66 cases) with acute coronary syndrome with a history of ischemic stroke in Shanghai Putuo District Central Hospital from May 2014 to March 2015 were randomly divided into control (31 cases) and treatment (35 cases) groups. All patients were given the conventional treatment without PCI treatment. Patients in the control group were po administrated with Clopidogrel Hydrogen Sulfate Tablets at loading dose of 300 mg, then with maintenance dose 75 mg, once daily. The patients in the treatment group were poadministered with Ticagrelor Tablets, at loading dose of 180 mg, then with maintenance dose 90 mg, twice daily. The patients in two groups were treated for 30 d. After treatment, the efficacy was evaluated. The cardiovascular adverse events (MACCE), incidence of bleeding events, and adverse drug reactions were compared, and levels of IL-6 and hs-CRP were determined at 7 and 30 d.Results After treatment, the efficacies in the control and treatment groups were 90.3% and 97.1%, respectively, and there were differences between two groups (P < 0.05). After treatment for 7 and 30 d, there were significant difference in MACCE and incidence of bleeding events between two groups (P < 0.05), but there were no significant difference in adverse drug reactions between two groups. After treatment for 7 and 30 d, the levels of IL-6 and hs-CRP in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05).Conclusions Ticagrelor Tablets has clinical curative effect in treatment of acute coronary syndrome with a history of ischemic stroke, can significantly reduce the incidence of MACCE, prohibit the levels of inflammatory cytokines, which be superior to Clopidogrel Hydrogen Sulfate Tablets and has a certain clinical application value.

上海市普陀區(qū)衛(wèi)生系統(tǒng)自主創(chuàng)新科研資助項(xiàng)目(2012PTKW005)