2020 年第 2 期 第 15 卷

老年冠状动脉粥样硬化性心脏病合并糖尿病患者经皮冠状动脉介入术后应用替格瑞洛和氯吡格雷的临床疗效比较

Clinical effects of ticagrelor and clopidogrel on elderly patient with coronary atherosclerotic heart disease and diabetes after percutaneous coronary intervention

作者：冯艳林1李毅1马瑞2白怀生3薛恩忠4李慧婷4

英文作者：

单位：1陕西省延安市人民医院老年病科716000；2陕西省延安市人民医院药剂科716000；3延安大学附属医院心血管内科716000；4陕西省延安市人民医院心血管内科716000

英文单位：

关键词：冠状动脉粥样硬化性心脏病；替格瑞洛；氯吡格雷；经皮冠状动脉介入；糖尿病

英文关键词：

• 摘要：

• 【摘要】目的    探讨替格瑞洛和氯吡格雷对老年冠状动脉粥样硬化性心脏病（冠心病）合并糖尿病患者经皮冠状动脉介入（PCI）术后的临床疗效。方法    选取2017年1月至2018年1月陕西省延安市人民医院拟行PCI治疗的老年冠心病合并糖尿病患者144例，按照随机数字表法分为观察组和对照组，每组72例。观察组在术后常规药物治疗的基础上给予替格瑞洛口服治疗（90 mg/次，2次/d），对照组在术后常规药物治疗的基础上给予硫酸氢氯吡格雷片口服治疗（75 mg/次，2次/d），2组均连续治疗12个月。比较2组患者治疗前后高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、血管内皮生长因子（VEGF）、基质金属蛋白酶9（MMP-9）水平。术后随访12个月，记录出血情况、重大心血管事件（缺血性脑卒中、心肌梗死、心源性死亡）及次要心血管事件（不稳定性心绞痛、支架血栓形成、靶血管血运重建）发生情况。结果    治疗前2组hs-CRP、IL-6、VEGF、MMP-9水平差异均无统计学意义（均P＞0.05）；治疗后2组hs-CRP、IL-6、VEGF、MMP-9水平明显低于治疗前，且观察组明显低于对照组［（1.9±0.4）mg/L比（3.2±0.8）mg/L、（2.1±0.8）μg/L比（3.8±1.0）μg/L、（85±15）ng/L比（119±17）ng/L、（30±5）μg/L比（52±7）μg/L］，差异均有统计学意义（均P＜0.05）。术后随访6个月，观察组出血发生率与对照组比较差异无统计学意义（P＞0.05）；随访12个月，观察组出血发生率明显低于对照组，差异有统计学意义［15.3%（11/72）比31.9%（23/72）］（P＝0.019）。观察组术后6、12个月次要心血管事件发生率和重大心血管事件发生率比较，差异均无统计学意义（均P＞0.05）。结论    替格瑞洛能降低老年冠心病合并糖尿病患者PCI术后血清炎性因子水平、稳定血小板，降低出血风险，同时并不增加心血管不良事件的发生。

• 【Abstract】Objective    To explore the clinical effects of ticagrelor and clopidogrel on elderly patient with coronary atherosclerotic heart disease(CHD) and diabetes after percutaneous coronary intervention（PCI）. Methods    A total of 144 elderly patients with CHD and diabetes undergoing PCI in Yan′an People′s Hospital, Shaanxi Province were randomly divided into observation group and control group, with 72 patients in each group. After PCI, the observation group took ticagrelor 90 mg twice daily and the control group took clopidogrel hydrochloride tablets 75 mg twice daily on the basis of routine medication. High-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), vascular endothelial growth factor(VEGF) and matrix metalloproteinase-9(MMP-9) were detected before and after 12 months of treatment. Bleeding events, major cardiovascular events(ischemic stroke, myocardial infarction, cardiogenic death) and secondary cardiovascular events(unstable angina, stent thrombosis, target vessel revascularization) were observed. Results    There were no significant differences of hs-CRP, IL-6, VEGF and MMP-9 levels between groups before treatment(all P＞0.05). After treatment, levels of hs-CRP, IL-6, VEGF and MMP-9 significantly decreased and the levels in observation group were significantly lower than those in control group［（1.9±0.4）mg/L vs （3.2±0.8）mg/L, （2.1±0.8）μg/L vs （3.8±1.0）μg/L, （85±15）ng/L vs （119±17）ng/L, （30±5）μg/L vs （52±7）μg/L］（all P＜0.05）. The 6-month bleeding rate showed no significant difference between groups（P＞0.05）. The 12-month bleeding rate in observation group was significantly lower than that in control group［15.3%（11/72） vs 31.9%（23/72）］（P＝0.019）. There was no significant difference in the incidences of major cardiovascular events and secondary cardiovascular events at 6 and 12 months between groups(all P＞0.05). Conclusion    Ticagrelor treating elderly patients with CHD and diabetes after PCI can reduce serum inflammatory factors, stabilize platelets, reduce the risk of bleeding and does not increase adverse cardiovascular events.