目的 对比伴缺血性脑梗死史急性冠脉综合征患者应用替格瑞洛片和硫酸氢氯吡格雷片的临床疗效和安全性。方法 选取2014年5月-2015年3月在上海市普陀区中心医院住院治疗的伴缺血性脑梗死史的急性冠脉综合征患者66例,随机分为对照组(31例)和治疗组(35例)。所有患者给予常规治疗,未行经皮冠脉介入(PCI)治疗。对照组口服硫酸氢氯吡格雷片300 mg负荷剂量,维持剂量75 mg,1次/d。治疗组口服替格瑞洛片180 mg负荷剂量,维持剂量90 mg,2次/d。两组均连续治疗30 d。观察两组的临床疗效,比较两组给药后7、30 d的主要心脑血管不良事件(MACCE)发生率、出血事件发生率和不良反应发生率,并检测患者血清白细胞介素6(IL-6)、高敏C反应蛋白(hs-CRP)水平。结果 治疗后,对照组和治疗组的总有效率分别为90.3%、97.1%,两组总有效率比较差异具有统计学意义(P<0.05)。治疗7、30 d后,两组MACCE发生率、出血事件发生率比较差异具有统计学意义(P<0.05),不良反应发生率的差异无统计学意义。治疗7、30 d后,两组IL-6、hs-CRP水平较治疗前显著下降,同组治疗前后差异具有统计学意义(P<0.05),且治疗组这些观察指标的下降程度优于对照组,两组比较差异具有统计学意义(P<0.05)。结论 替格瑞洛片治疗伴缺血性脑梗死史的急性冠脉综合征具有较好的临床疗效,能显著降低MACCE发生率,抑制炎性因子水平,其效果优于硫酸氢氯吡格雷片,具有一定的临床推广应用价值。

Objective To compare the clinical curative and safety of Ticagrelor Tablets and Clopidogrel Hydrogen Sulfate Tablets in treatment of acute coronary syndrome with a history of ischemic stroke.Methods Patients (66 cases) with acute coronary syndrome with a history of ischemic stroke in Shanghai Putuo District Central Hospital from May 2014 to March 2015 were randomly divided into control (31 cases) and treatment (35 cases) groups. All patients were given the conventional treatment without PCI treatment. Patients in the control group were po administrated with Clopidogrel Hydrogen Sulfate Tablets at loading dose of 300 mg, then with maintenance dose 75 mg, once daily. The patients in the treatment group were poadministered with Ticagrelor Tablets, at loading dose of 180 mg, then with maintenance dose 90 mg, twice daily. The patients in two groups were treated for 30 d. After treatment, the efficacy was evaluated. The cardiovascular adverse events (MACCE), incidence of bleeding events, and adverse drug reactions were compared, and levels of IL-6 and hs-CRP were determined at 7 and 30 d.Results After treatment, the efficacies in the control and treatment groups were 90.3% and 97.1%, respectively, and there were differences between two groups (P < 0.05). After treatment for 7 and 30 d, there were significant difference in MACCE and incidence of bleeding events between two groups (P < 0.05), but there were no significant difference in adverse drug reactions between two groups. After treatment for 7 and 30 d, the levels of IL-6 and hs-CRP in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05).Conclusions Ticagrelor Tablets has clinical curative effect in treatment of acute coronary syndrome with a history of ischemic stroke, can significantly reduce the incidence of MACCE, prohibit the levels of inflammatory cytokines, which be superior to Clopidogrel Hydrogen Sulfate Tablets and has a certain clinical application value.

上海市普陀区卫生系统自主创新科研资助项目(2012PTKW005)