王　强，李子玲，徐　平，何永桂(1.解放军第184医院心血管内科，江西 鹰潭　5000； .安徽省濉溪县人民医院心血管内科，安徽 淮北　5000； .安徽省濉溪县中医院心血管内科，安徽 淮北　5000)



氯吡格雷治疗稳定型冠心病的疗效观察

王强1*，李子玲2，徐平2，何永桂3(1.解放军第184医院心血管内科，江西 鹰潭335000； 2.安徽省濉溪县人民医院心血管内科，安徽 淮北235000； 3.安徽省濉溪县中医院心血管内科，安徽 淮北235000)

DOI10.14009/j.issn.1672-2124.2016.02.003

摘要目的：探讨氯吡格雷治疗稳定型冠心病的临床疗效。方法：选取2014年1月—2015年1月收治的稳定型冠心病患者180例，按随机数字表法分为2组各90例，2组患者均常规给予调脂、降压、控制血糖及抗心肌缺血等药物治疗。观察组患者在常规治疗基础上给予氯吡格雷治疗，对照组患者在常规治疗基础上给予阿司匹林治疗。随访30 d，比较2组患者血小板聚集率(platelet aggregation rate,PAR)改变情况、心绞痛发作时间、心电图ST段改善情况以及不良反应发生情况。结果：观察组患者PAR由治疗前的(63.7±10.2)%降低为治疗后的(42.3±9.1)%，对照组由治疗前的(62.8±9.4)%降低为治疗后的(49.4±10.2)%，均较同组治疗前明显降低，且观察组降低幅度大于对照组，差异有统计学意义(P<0.05)。观察组患者病情恶化3例(3.7%)，对照组10例(10.1%),2组的差异有统计学意义(P<0.05)；观察组患者的总有效率为96.7%，高于对照组的71.1%，差异有统计学意义(P<0.05)；观察组患者心绞痛发作平均时间为(1.3±1.1) d，低于对照组的(2.4±1.2) d，2组的差异有统计学意义(P<0.05)；观察组患者心电图ST段改善总有效率为86.7%，高于对照组的70.0%，2组的差异有统计学意义(P<0.05)。观察组患者出现1例胃肠道不适(1.1%)，对照组出现4例(4.5%)牙龈出血及4例消化道出血(4.5%)，2组的差异有统计学意义(P<0.05)；观察组患者的成本-效果比为1.0，对照组为1.1,2组的差异有统计学意义(P<0.05)。结论：氯吡格雷与阿司匹林对稳定型冠心病患者临床疗效均较好，但氯吡格雷临床疗效及安全性更理想，值得临床推广。

关键词氯吡格雷； 阿司匹林； 稳定型冠心病； 心绞痛

Observation on Efficacy of Clopidogrel Combined with Aspirin in Treatment of Stable Coronary Heart Disease

WANG Qiang1, LI Ziling2, XU Ping2, HE Yonggui3(1.Dept.of Vasculocardiology， 184 Hospital of Chinese People’s Liberation Army, Jiangxi Yingtan 335000, China; 2.Dept.of Vasculocardiology，People’s Hospital of SuiXi County, Anhui Suixi 235000, China; 3.Dept.of Vasculocardiology，Chinese medicine Hospital of SuiXi County, Anhui Suixi 235000, China)

ABSTRACTOBJECTIVE：To investigate the clinical efficacy of clopidogrel combined with aspirin in treatment of stable coronary heart disease. METHODS: 180 cases with stable coronary artery disease admitted into hospital from Jan. 2014 to Jan. 2015 were selected to be divided into two groups via the random number table, with 90 cases in each. All patients were given routinely lipid regulation, blood pressure, blood glucose control and anti-ischemic drug therapy. Based on the routine therapy, the observation group received clopidogrel, while the control group received aspirin. After follow-up of 30 d, the changes of platelet aggregation rate(PAR), attack time of angina, improvement of ST in ECG and occurrence of adverse reactions were compared between two group of patients. RESULTS: The PAR in observation group decreased from (63.7±10.2)% before treatment to (42.3±9.1)% after treatment, as for the control group, it decreased from (62.8±9.4)% to (49.4±10.2)%, the data were significantly lower than before treatment for the same group, and the decline in observation group was significantly greater than than of control group, with statistically significance(P<0.05). There were 3 cases (3.7%) with the deterioration of diseases in observation group, 10 cases(10.1%) in control group, the difference was statistically significant between two groups(P<0.05). The total effective rate of observation group were 96.7%, significantly higher than that of control group 71.1%, with statistical significance(P<0.05). The average attack time of angina in observation group were (1.3±1.1) d, significantly lower than that in control group(2.4±1.2) d, the difference was statistically significant (P<0.05). Meanwhile, the total effective rate of improvement of ST in ECG in observation group were 86.7%, higher than that in control group 70.0%, the difference was statistically significant (P<0.05). And one case (1.1%) with intestinal discomfort in observation group, 4 cases (4.5%) with gingival bleeding and 4 cases of (4.5%) with digestive tracthemorrhage in control group, with statistically significant difference (P<0.05). CONCLUSIONS: The clinical efficacy of clopidogrel and aspirin in treatment of stable coronary heart disease is relatively good, but clopidogrel has a safer clinical effect, which is worthy of worthy of clinical popularization and application.

KEYWORDSClopidogrel; Aspirin; Stable coronary artery disease; Angina

冠状动脉粥样硬化性心脏病主要是由于冠状动脉粥样硬化使血管腔狭窄，导致心肌缺血、缺氧而引起的心脏病，简称“冠心病”，包括稳定型和不稳定型两类。稳定型冠心病是一种慢性冠心病，包括无心绞痛发作和稳定性劳力型心绞痛，若不及时防治，很可能会进展成为不稳定性心绞痛和心肌梗死，威胁人类健康。……