杨兆瑞　刘芳　傅艳　丁春平　宋敏青　幸志强　刘玉　王芳

【摘要】 目的：比較氯吡格雷与替格瑞洛应用于急性心肌梗死介入治疗的效果。方法：选取2014年3月-2015年9月因急性心肌梗死入院接受经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）的患者124例进行研究，将其按照随机数字表法分为氯吡格雷组与替格瑞洛组，每组62例。两组患者分别服用氯吡格雷和替格瑞洛，同时加服阿司匹林。术后对两组患者进行随访，评价并比较两种药物治疗急性心肌梗死PCI术后的临床效果以及安全性相关指标。结果：替格瑞洛组治疗后第1、3、6个月血小板聚集率及主要不良心脑血管事件（MACE）发生率均明显低于氯吡格雷组（P<0.05）；第6个月时替格瑞洛组血栓发生率明显低于氯吡格雷（P<0.05）；治疗后两组患者血肌酐、谷草转氨酶水平比较，差异均无统计学意义（P>0.05）。两组患者出血发生率比较，差异无统计学意义（P>0.05），替格瑞洛组患者呼吸困难发生率明显高于氯吡格雷组（P<0.05）。结论：在进行心肌梗死患者的介入治疗中，替格瑞洛能够更快地产生更为强大的抑制血小板聚集作用，可降低MACE发生的风险，同时不增加出血风险，具有较高的安全性。

【关键词】 替格瑞洛； 氯吡格雷； 急性心肌梗死； 经皮冠状动脉介入治疗

Comparative Study of the Therapeutic Effect of Clopidogrel and Ticagrelor in Interventional Therapy for Acute Myocardial Infarction/YANG Zhao-rui，LIU Fang，FU Yan，et al.//Medical Innovation of China，2017，14（02）：071-074

【Abstract】 Objective：To compare the therapeutic effect of Clopidogrel and Ticagrelor in acute myocardial infarction interventional therapy.Method：A total of 124 cases patients admitted to PCI from March 2014 to September 2015 due to acute myocardial infarction were selected and randomly divided into Clopidogrel group and Ticagrelor group，62 cases in each group.Two groups of patients were taking Clopidogrel and Ticagrelor，plus Aspirin.After the operation，two groups of patients were followed up to evaluate and compare the clinical efficacy and safety of two drugs in the treatment of acute myocardial infarction after PCI.Result：Platelet aggregation rate and major adverse cardiovascular events（MACE） of Ticagrelor group were significantly lower than those of Clopidogrel group at the first month，third months，sixth months after treatment（P<0.05）.Thrombosis rate of Ticagrelor group was significantly lower than that of Clopidogrel group at the sixth months after treatment （P<0.05）.After treatment，serum creatinine and aspartate aminotransferase levels of two groups had no significant difference（P>0.05）.There was no significant difference in the incidence of bleeding of two groups（P>0.05）.Dyspnea incidence of Ticagrelor group was significantly higher than that of Clopidogrel group（P<0.05）.Conclusion：In the treatment of myocardial infarction，Ticagrelor can quickly produce more powerful inhibition of platelet aggregation，can reduce the risk of MACE，but does not increase the difficulty in bleeding.It has a high security，is worthy of clinical application.

【Key words】 Ticagrelor； Clopidogrel； Acute myocardial infarction； Percutaneous coronary intervention

First-authors address：Yichun Peoples Hospital，Yichun 336000，China

doi：10.3969/j.issn.1674-4985.2017.02.018

急性心肌梗死是冠状动脉急性、持续性缺血缺氧导致的心肌坏死，患者多表现出剧烈且持续的胸骨后疼痛，休息和硝酸脂类药物不能完全缓解，可并发休克、心律失常、心力衰竭等，会危及生命[1]。经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）是改善心肌血流灌注的有效方法之一，无论是非ST段抬高性心肌梗死高危患者还是急性ST段抬高型患者，均提倡应尽早介入治疗以尽可能挽救濒死心肌，降低患者急性期的死亡风险，积极改善长期预后[2]。虽然PCI治疗急性心肌梗死效果好且成功率高，但术后心血管事件的发生率也相对较高[3]。临……