2025 年第 2 期 第 20 卷

替格瑞洛治疗伴严重肾脏病的急性冠状动脉综合征患者的效果及安全性

The efficacy and safety of ticagrelor in the treatment of acute coronary syndrome patients with severe renal disease

作者：郭丽娟1袁玉婷2孙星河1张贤1杨泉1刘小慧1

英文作者：Guo Lijuan1 Yuan Yuting2 Sun Xinghe1 Zhang Xian1 Yang Quan1 Liu Xiaohui1

单位：1北京大学国际医院心血管内科，北京102206；2首都医科大学附属北京朝阳医院心血管内科，北京100020

英文单位：1Department of Cardiology Peking University International Hospital Beijing 102206 China; 2Department of Cardiology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

关键词：急性冠状动脉综合征；严重肾脏病；替格瑞洛；氯吡格雷

英文关键词：Acutecoronarysyndrome;Severekidneydisease;Ticagrelor;Clopidogrel

• 摘要：

• 目的  观察替格瑞洛治疗伴严重肾脏病的急性冠状动脉综合征（ACS）患者的效果和安全性。方法回顾性选取2018年7月至2023年3月北京大学国际医院心血管内科收治的伴严重肾脏病［估算肾小球滤过率＜30 ml/(min·1.73 m2)］的ACS患者115例。根据患者服用的抗血小板药物种类将患者分为替格瑞洛组（38例）和氯吡格雷组（77例），替格瑞洛组使用阿司匹林肠溶片100 mg/次、1次/d联合替格瑞洛90 mg/次、2次/d口服抗血小板治疗，氯吡格雷组使用阿司匹林肠溶片100 mg/次、1次/d联合氯吡格雷75 mg/次、2次/d口服抗血小板治疗。随访患者出院后1年的主要不良心血管事件（MACE）和出血事件发生情况。结果 替格瑞洛组N末端B型脑钠肽前体水平及左心房前后径低于/小于氯吡格雷组［3 343.0（1 707.0，7 125.5）ng/L比11 401.0（4 818.5，31 174.0）ng/L、（41±7）mm比（44±7）mm］，急性心肌梗死比例及冠状动脉Gensini评分高于氯吡格雷组［89.5%（34/38）比57.1%（44/77）、（74±43）分比（59±31）分］（均P＜0.05）。2组患者出院后1年MACE发生率差异无统计学意义（P＞0.05），替格瑞洛组总出血事件发生率与氯吡格雷组比较，差异无统计学意义（P=0.716），但4例致死性出血事件均出现在氯吡格雷组。结论 伴严重肾脏病的ACS患者使用以替格瑞洛为基础的双联抗血小板药物治疗的效果及安全性可靠。

• Objective To observe the efficacy and safety of ticagrelor in the treatment of acute coronary syndrome (ACS) patients with severe renal disease. Methods A total of 115 ACS patients with severe kidney disease ［estimated glomerular filtration rate < 30 ml/(min·1.73 m2)］ admitted to the Department of Cardiology, Peking University International Hospital from July 2018 to March 2023 were retrospectively selected. The patients were divided into ticagrelor group (38 cases) and clopidogrel group (77 cases) according to the type of antiplatelet drugs taken by the patients. Ticagrelor group was treated with aspirin enteric-coated tablets 100 mg/time, once a day combined with ticagrelor 90 mg/time, twice a day oral antiplatelet therapy. Clopidogrel group was treated with aspirin enteric-coated tablets 100 mg/time, once a day combined with clopidogrel 75 mg/time, twice a day oral antiplatelet therapy. Patients were followed up for 1 year after discharge for major adverse cardiovascular events (MACE) and bleeding events. Results The levels of N-terminal pro-brain natriuretic peptide and left atrial anteroposterior diameter were lower/smaller in ticagrelor group than in clopidogrel group ［3 343.0（1 707.0，7 125.5）ng/L vs 11 401.0（4 818.5，31 174.0）ng/L,（41±7）mm vs （44±7）mm］, and the incidence of acute myocardial infarction and coronary Gensini score were higher in the clopidogrel group than in the clopidogrel group ［89.5%（34/38） vs 57.1%（44/77）, （74±43） vs （59±31）］(all P＜0.05). There was no significant difference in the incidence of MACE between the two groups at 1 year after discharge (P＞0.05). There was no significant difference in the incidence of bleeding events between the ticagrelor group and the clopidogrel group (P=0.716). However, all four cases fatal bleeding events occurred in the clopidogrel group. Conclusion Ticagrelor-based dual antiplatelet therapy is effective and safe for ACS patients with severe renal disease.