目的 探討急性冠脈綜合征（ACS）患者接受經(jīng)皮冠狀動(dòng)脈介入治療（PCI）后服用替格瑞洛和阿司匹林雙聯(lián)抗血小板治療出現(xiàn)不良反應(yīng)的特點(diǎn)及危險(xiǎn)因素。方法 前瞻性納入2018年3月—2018年6月鄭州市第七人民醫(yī)院收治的PCI術(shù)后服用替格瑞洛和阿司匹林的ACS患者100例，采用VerifyNow-P2Y12系統(tǒng)檢測患者血小板反應(yīng)性并隨訪6個(gè)月，根據(jù)是否發(fā)生相關(guān)不良反應(yīng)分為對照組和不良反應(yīng)組，收集對比兩組患者臨床基線資料，采用單因素和多因素Logistic回歸分析出血和呼吸困難的危險(xiǎn)因素。結(jié)果 納入研究的患者未出現(xiàn)不良反應(yīng)的40例納入對照組，出現(xiàn)不良反應(yīng)的60例納入不良反應(yīng)組，雙聯(lián)抗血小板治療相關(guān)不良反應(yīng)發(fā)生率60.0%，84例（84.0%）患者存在低血小板反應(yīng)性。兩組患者在年齡、性別、合并疾病、血小板反應(yīng)性等方面差異不具有統(tǒng)計(jì)學(xué)意義（P＞0.05），不良反應(yīng)組吸煙患者占比明顯高于對照組（51.7%vs27.5%，P=0.016）。不良反應(yīng)主要臨床表現(xiàn)為皮膚黏膜出血和輕中度呼吸困難，用藥后1個(gè)月內(nèi)出血和呼吸困難發(fā)生率顯著高于用藥后2～6個(gè)月（出血發(fā)生率：38.0%vs1.0%，P＜0.001；呼吸困難發(fā)生率：32.0%vs8.0%，P＜0.001）。多因素Logisitc回歸分析顯示老年、女性和貧血是雙聯(lián)抗血小板治療相關(guān)出血的獨(dú)立危險(xiǎn)因素（P＜0.05），吸煙和出血事件是雙聯(lián)抗血小板治療相關(guān)呼吸困難的獨(dú)立危險(xiǎn)因素（P＜0.05）。結(jié)論 ACS患者PCI術(shù)后雙聯(lián)抗血小板治療早期出血和呼吸困難發(fā)生率高但程度較輕，對于合并危險(xiǎn)因素的患者應(yīng)提前評估、加強(qiáng)監(jiān)測，最大限度地降低藥品不良反應(yīng)的發(fā)生。

Objective To investigate the characteristics and risk factors of adverse reactions related to dual antiplatelet therapy of ticagrelor and aspirin in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods Prospectively included 100 patients with ACS who took ticagrelor and aspirin after PCI in Zhengzhou Seventh People's Hospital from March 2018 to June 2018. The platelet reactivity of the patients was detected by VerifyNow-P2Y12 system and followed up for six months. The patients were divided into control group and adverse reaction group according to whether there was related adverse reaction. The clinical baseline data of the two groups were collected and compared. The risk factors of hemorrhage and dyspnea were analyzed by single factor and multiple factor Logistic regression.Results A total of 40 patients without adverse reactions were included in the control group, and 60 patients with adverse reactions were included in the adverse reaction group. The incidence of adverse reactions related to dual antiplatelet therapy was 60.0%, and 84 patients (84.0%) had low platelet reactivity. There was no significant difference between the two groups in terms of age, sex, comorbidity, platelet reactivity, etc (P > 0.05). The proportion of smokers in the adverse reaction group was significantly higher than that in the control group (51.7% vs 27.5%, P = 0.016). The main clinical manifestations of adverse reactions were skin mucosal hemorrhage and mild to moderate dyspnea. The incidence of bleeding and dyspnea within one month after administration was significantly higher than that of two to six months after administration(bleeding incidence: 38.0% vs 1.0%, P <0.001. Dyspnea incidence: 32.0% vs 8.0%, P <0.001). Multivariate Logisitc regression analysis showed that old age, women and anemia were independent risk factors for bleeding associated with dual antiplatelet therapy (P <0.05), and smoking and bleeding events were independent risk factors for dyspnea associated with dual antiplatelet therapy (P <0.05).Conclusion The incidence of early bleeding and dyspnea in ACS patients treated with dual antiplatelet therapy after PCI is high, but the degree is relatively low. Patients with risk factors should be evaluated in advance and monitored to minimize the occurrence of adverse drug reactions.

R972

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建項(xiàng)目(LHGJ20210749)