目的 探讨替罗非班联合阿司匹林和氯吡格雷治疗糖尿病合并急性心肌梗死的临床研究。方法 选择2018年6月—2020年2月在河北港口集团有限公司港口医院行急诊经皮冠状动脉介入治疗（PCI）的112例糖尿病合并急性心肌梗死患者，将其随机分为三联组（n=56）和二联组（n=56）。二联组口服阿司匹林肠溶片300 mg/d和氯吡格雷片300 mg/d，PCI后给予阿司匹林肠溶片100 mg/d和氯吡格雷片75 mg/d，服用6个月。三联组在二联组的基础上静脉滴注替罗非班注射液，起始0.5 h内以0.4 μg/（kg·min）的速率滴注，之后维持滴注的速率变为0.1 μg/（kg·min）。比较两组临床疗效、血糖水平［餐后2 h血糖（2 h PG）、空腹血糖（FPG）］、心功能指标［左室射血分数（LVEF）、左室短轴缩短分数（LVFS）］、血小板活化参数（CD62P、CD63）及出血不良事件发生情况。结果 治疗后，观察组的总有效率为91.07%，显著高于对照组的76.79%（P<0.05）。治疗后，两组患者FPG、2 h PG较治疗前差异无统计学意义。治疗后，两组患者LVFS、LVEF较治疗前显著升高（P<0.05）；且三联组患者LVFS、LVEF显著高于二联组（P<0.05）。治疗后，两组患者CD62P、CD63较治疗前显著下降（P<0.05）；且三联组患者CD62P、CD63显著低于二联组（P<0.05）。两组出血不良事件发生率比较差异无统计学意义。结论 替罗非班联合阿司匹林和氯吡格雷治疗糖尿病合并急性心肌梗死患者短期疗效较好，能够改善患者心功能，降低血小板活化水平，且对患者的血糖水平无明显影响，不会增加出血不良事件发生率，值得进一步研究和推广。

Objective To investigate efficacy of tirofiban combined with aspirin and clopidogrel in treatment of diabetes mellitus complicated with acute myocardial infarction. Methods A total of 112 patients with diabetes mellitus complicated with acute myocardial infarction who underwent emergency percutaneous coronary intervention (PCI) in Port Hospital of Hebei Port Group Co., Ltd from June 2018 to February 2020 were selected and randomly divided into triple antiplatelet (n=56) and double antiplatelet group (n=56). Patients in the double antiplatelet group were po administered with Aspirin Enteric-coated Tablets, 300 mg/d and Clopidogrel Tablets 300 mg/d, and 100 mg/d Aspirin Enteric-coated Tablets, 75 mg/d Clopidogrel Tablets were given after PCI for 6 months. Patients in the triple antiplatelet group were iv administered with Tirofiban Injection on the basis of two antiplatelet group at a rate of 0.4 μg/(kg·min) for the first half hour, and then at a rate of 0.1 μg/(kg·min) for maintenance. After treatment, the clinical efficacy, blood glucose level [2 h postprandial blood glucose (2 h PG), fasting blood glucose (FPG)], cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular short axis fraction (LVFS)], platelet activation parameters (CD62P, CD63), and the occurrence of bleeding adverse events were compared between two groups. Results After treatment, the total effective rate of triple group was 91.07%, which was significantly higher than 76.79% of double group, and the difference was statistically significant (P < 0.05). After treatment, there was no significant difference in FPG and 2 h P G between two groups compared with before treatment. After treatment, LVFS and LVEF in two groups were significantly increased compared with before treatment (P < 0.05), and LVFS and LVEF in triple group were significantly higher than those in double group (P < 0.05). After treatment, CD62P and CD63 in two groups were significantly decreased compared with before treatment (P < 0.05), and CD62P and CD63 in triple group were significantly lower than those in double group (P < 0.05). There was no significant difference in the incidence of bleeding adverse events between two groups. Conclusion Tilofiban combined with aspirin and clopidogrel in treatment of patients with diabetes mellitus complicated with acute myocardial infarction has good short-term efficacy, can improve the cardiac function of patients, reduce platelet activation level, and has no significant effect on the blood glucose level of patients, will not increase the incidence of bleeding adverse events, worthy of further research and promotion.

R972

秦皇岛市科学技术研究与发展计划项目（201703A208）