不同双联抗血小板治疗对急性冠脉综合征合并2型糖尿病患者PCI术后抗血小板疗效比较

发布时间：2018-02-08 14:49

本文关键词： 急性冠脉综合征 2型糖尿病经皮冠状动脉介入治疗替格瑞洛氯吡格雷　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的比较阿司匹林联合替格瑞洛与氯吡格雷双联抗血小板治疗对急性冠脉综合征(ACS)合并2型糖尿病患者急诊冠状动脉介入治疗(PCI)术后抗血小板的疗效,旨在探求急性冠脉综合征(ACS)合并2型糖尿病患者急诊冠状动脉介入治疗(PCI)术后抗血小板的最佳药物治疗方案。方法选取兰州石化总医院拟行冠脉介入术治疗的急性冠脉综合征合并糖尿病患者115例,随机分为替格瑞洛组(A组,n=52例)与氯吡格雷组(B组,n=63例)。A组术前接受负荷量阿司匹林300mg+替格瑞洛180mg,术后给予替格瑞洛90 mg,2次/日,阿司匹林100 mg,1次/日维持;B组术前接受负荷量阿司匹林300 mg+氯吡格雷300 mg,术后给予氯吡格雷75mg、阿司匹林100mg,1次/日维持。入选患者均于服药前、PCI术后2月、4月采集静脉血,测定血小板活性功能指标CD62P、CD63和血小板最大聚集率(MPAR)。观察并比较在服药治疗6个月内两组患者不良心血管事件和并发症的发生情况。采用IBM SPSS20.0统计软件包进行统计学处理,用率表示计数资料,采用?2检验,用均数±标准误(?x±s)表述定量资料。采用t检验比较两组间的均数,P0.05差异有统计学意义。结果两组患者PCI术前血糖水平、基线资料等指标差异均无统计学意义,PCI术前血小板活性功能指标CD62P、CD63及血小板聚集功能指标MPAR的差异也无统计学意义。PCI术后双联抗血小板治疗2月后,A、B两组血小板活性功能指标CD62P、CD63及血小板聚集功能指标MPAR较术前均有明显下降(P0.05),治疗4月后,上述指标的数值继续下降,且A、B两组间的差异具有统计学意义(P0.05);术后随访6月,主要不良心血管事件发生率替格瑞洛组低于氯吡格雷组,组间差异有统计学意义(P0.05)。结论急性冠脉综合征合并2型糖尿病PCI术后患者,更能有效抑制血小板功能,降低血小板聚集率的是替格瑞洛联合阿司匹林双联抗血小板治疗,术后6个月主要不良心血管事件的发生率更低,出血风险更小。
[Abstract]:Objective to compare the antiplatelet effect of aspirin combined with tigrilol and clopidogrel in patients with acute coronary syndrome (ACS) complicated with type 2 diabetes mellitus after emergency coronary intervention therapy (PCI). The aim of this study was to explore the best anti-platelet drug regimen for patients with acute coronary syndrome (ACS) complicated with type 2 diabetes mellitus after emergency coronary intervention therapy (PCI). Methods the acute coronary intervention therapy in Lanzhou Petrochemical General Hospital was selected. 115 cases of sexual Coronary Syndrome complicated with Diabetes Mellitus, They were randomly divided into tigrilol group (n = 52) and clopidogrel group (n = 63) and group A (n = 63) received aspirin 300mg tigrilol 180 mg before operation, and were given tigrilol 90 mg / d after operation. Group B received a dose of 300 mg clopidogrel 300 mg before operation, 75 mg of clopidogrel and 100 mg / d of aspirin once a day. Venous blood was collected before and after PCI on February and April. The platelet active function index CD62PU CD63 and the maximum platelet aggregation rate (MPAR) were measured. Adverse cardiovascular events and complications were observed and compared between the two groups within 6 months after treatment. The data were analyzed by IBM SPSS20.0 software package. Use rate to represent counting data, use? 2 test with mean 卤standard error? T test was used to compare the difference of mean value between the two groups (P0.05). Results the blood glucose level before PCI in the two groups was significantly higher than that in the control group. There was no significant difference between baseline data and other indexes. There was no significant difference in platelet active function index CD62Pnc63 and platelet aggregation function index MPAR before PCI. There was no significant difference between two groups after PCI. After February, two groups of platelets were treated with double antiplatelet therapy. The activity function index CD62PU CD63 and platelet aggregation function index (MPAR) were significantly lower than those before operation (P 0.05). The values of the above indexes continued to decrease, and the difference between the two groups was statistically significant (P 0.05), and the incidence of major adverse cardiovascular events in tigrillo group was lower than that in clopidogrel group on June. Conclusion the patients with acute coronary syndrome complicated with type 2 diabetes mellitus after PCI can effectively inhibit platelet function and reduce platelet aggregation rate by using tigrilol combined with aspirin as a combined antiplatelet therapy, the difference between the two groups is significant (P0.050.Conclusion the patients with acute coronary syndrome complicated with type 2 diabetes mellitus after PCI can effectively inhibit platelet function and reduce platelet aggregation rate. The incidence of major adverse cardiovascular events was lower and the risk of bleeding was lower 6 months after operation.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R587.1

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