学术论文

      盐酸替罗非班在复杂冠状动脉病变介入治疗中的临床观察

      Clinical observation on tirofiban in treatment of complex coronary artery lesions with percutaneous ;coronary intervention

      摘要:
      目的:评价盐酸替罗非班在复杂冠状动脉病变介入治疗中的有效性及安全性。方法连续选取北京军区总医院心研所2013年4月至2014年4月期间收治的诊断为冠状动脉粥样硬化性心脏病(冠心病),经冠状动脉造影证实为复杂冠状动脉病变的患者,共104例,其中男性56例,女性48例,年龄50~72岁,平均年龄(61.73±6.43)岁。随机分为对照组(n=52)及盐酸替罗非班治疗组即强化组(n=52)。对照组给予介入治疗,低分子肝素、口服阿司匹林片皮下注射、氯吡格雷片、他汀类药物、β受体阻滞剂和或ACEI类药物。强化组在对照组用药基础上,给予盐酸替罗非班冠脉内注入及静脉维持治疗。评估两组PCI术后30 d的主要不良心血管事件(MACE)。检测术后肌钙蛋白I(TNI)、手术前后高敏C-反应蛋白(hs-CRP)变化。记录术后心绞痛发作情况及出血、血小板减少等情况。结果强化组TNI和△hs-CRP明显低于对照组,分别为[(0.11±0.05)ng/ml vs.(1.22±0.83)ng/ml]、[(1.59±0.58)mg/L vs.(5.68±1.34)mg/L],差异有显著统计学意义(P均<0.01)。强化组无MACE发生,对照组发生1例于15 d时不明原因猝死,1例亚急性支架血栓形成致急性心肌梗死。两组均有心绞痛发生,强化组明显低于对照组(1.9%vs.15.4%),有统计学意义(P=0.031)。术后TIMI血流3级比例强化组高于对照组(100%vs.88.5%),TIMI血流2级比例强化组低于对照组(0%vs.11.5%),差异均有统计学意义(P均<0.05)。强化组发生1例轻微出血,为出血点,停用替罗非班后,出血点减少。2例小出血,分别是血尿和鼻出血。对照组2例轻微出血,为眼结膜充血和牙龈出血。1例小出血为术后穿刺部位出血。强化组术后血红蛋白下降幅度大于对照组[(1.81±0.565)g/L vs.(1.62±0.530)g/L],但无统计学意义(P=0.078);血小板减少症(GIT)仅在强化组发生1例,并且为轻度减少。结论盐酸替罗非班在复杂冠状动脉病变的介入治疗中疗效和安全性较好。
      Abstract:
      Objective To review the efficacy and safety of tirofiban in treatment of complex coronary artery lesions with percutaneous coronary intervention (PCI). Methods The patients with coronary heart disease (CHD) diagnosed as complex coronary artery lesions (n=104, male 56, female 48, aged from 50 to 72 and average age=61.73±6.43) were chosen from Apr. 2013 to Apr. 2014. All patients were randomly divided into control group and intensive group (each n=52). The control group was given PCI and low molecular weight heparin, aspirin, clopidogrel, statins, β-blockers and ACEI, and intensive group was given intravenous injection of tirofiban hydrochloride based on the same therapy and drugs as those in control group. After PCI for 30 d, major adverse cardiovascular events (MACE) were reviewed in 2 groups. The changes of cardiac troponin I (TNI) and high-sensitivity C-reactive protein (hs-CRP) were detected, and incidence of angina attack, bleeding and thrombocytopenia were recorded after PCI. Results The levels of cTnI and hs-CRP were significantly lower in intensive group than those in control group [(0.11±0.05) ng/mL vs. (1.22±0.83) ng/mL, (1.59±0.58) mg/L vs. (5.68±1.34) mg/L, all P<0.01]. There was no MACE in intensive group, and 1 case of unexplained sudden death on the 15th d and 1 case of acute myocardial infarction due to in-stent subacute thrombosis in control group. There were cases of angina pectoris in 2 groups but much less in intensive group than those in control group (1.9%vs. 15.4%, P=0.031). The percentage of patients with grade-3 TIMI was higher in intensive group than that in control group (100%vs. 88.5%) and that with grade-2 TIMI was lower in intensive group than that in control group (0%vs. 11.5%, all P<0.05). In intensive group, 1 case had slight bleeding (petechia) and was relieved after stopping tirofiban, and 2 cases had minor bleed (hematuresis and hemorrhinia). In control group, 2 cases had slight bleeding (conjunctival congestion and gingival bleeding) and 1 case had minor bleeding (bleeding at puncture point). The descend range of hemoglobin was higher in intensive group than that in control group [(1.81±0.565) g/L vs. (1.62±0.530) g/L] without statistical significance (P=0.078). There was only 1 case of mild thrombocytopenia in intensive group. Conclusion Tirofiban hydrochloride has good curative effect and higher safety in treatment of complex coronary artery lesions with PCI.
      作者: 胡雪红 [1] 李运田 [2] 李俊峡 [3] 谭琛 [3]
      Author: HU Xue-hong [1] LI Yun-tian [2] LI Jun-xia [3] TAN Chen [3]
      作者单位: 南方医科大学, 广州,510515 南方医科大学解放军305医院心内科 北京军区总医院心研所
      年,卷(期): 2015, (3)
      分类号: R816.2
      机标分类号: R54 R96
      在线出版日期: 2015年7月14日