何晓雷

[摘要] 目的 分析在基层医院应用替格瑞洛治疗急性冠脉综合征的临床效果及安全性。 方法 回顾性分析2015年1月～2017年5月于北京市延庆区医院就诊的急性冠脉综合征患者97例，根据选择的抗双联抗血小板方案分为两组：替格瑞洛组（同时服用替格瑞洛和阿司匹林，n = 49）和氯吡格雷组（同时服用氯吡格雷和阿司匹林，n = 48）。随访6个月，比较两组主要不良心血管事件、出血风险及药物不良反应发生率。 结果 替格瑞洛组患者的主要不良心血管件发生率（2.04%）显著低于氯吡格雷组（14.58%），差异有统计学意义（P < 0.05），但两组患者出血事件发生率比较差异无统计学意义（P > 0.05）。替格瑞洛组药物不良反应发生率为18.4%，氯吡格雷组药物不良反应发生率为6.25%，两组比较差异无统计学意义（P > 0.05）。 结论 应用替格瑞洛联合阿司匹林治疗急性冠脉综合征可显著降低患者的心血管不良事件发生率，不增加出血风险，安全有效，值得基层医院推广。

[关键词] 冠心病；替格瑞洛；安全性；疗效

[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0092-04

[Abstract] Objective To analyze the clinical efficacy and safety of Ticagrelor in the treatment of patients with acute cornoary syndrome（ACS） in the basic level hospital. Methods A total of 97 patients with acute coronary syndrome was analyzed retrospectively in Beijing Yanqing Hospital from January 2015 to May 2017. According to dual antiplatelet therapy， they were divided into Ticagrelor group （n = 49， treated with Ticagrelor combined with Aspirin） and Clopidogrel group （n = 48， treated with Clopidogrel combined with Aspirin）. Major adverse cardiac events （MACE）， the risk of bleeding and adverse drug reactions（ADR） were compared after a follow-up of 6 months. Results Compared with the Clopidogrel group（14.58%）， the incidence of MACE of Ticagrelor group （2.04%） was significant decreased and there was significant difference （P < 0.05）. But there was no significant difference in the incidence of bleeding event rates between the two groups （P > 0.05）. Compared with the clopidogrel group （6.25%）， the ADR of ticagrelor group （18.4%） was increased， but there was no statistically significant difference（P > 0.05）. Conclusion Ticagrelor combined with Aspirin can decrease the MACE incidence of ACS and do not increase the risk of bleeding. It is safe， effective and worth popularizing in the basic level hospital.

[Key words] Coronary heart disease； Ticagrelor； Safety； Efficacy

動脉粥样硬化的病理过程贯穿冠心病病史全程，管腔狭窄程度并不能准确反映动脉粥样硬化斑块的严重程度和稳定性[1]，急性冠脉综合征病理生理机制是在斑块破裂的基础上诱发急性血栓形成，血小板活化在其中发挥了重要作用[2]。阿司匹林联合P2Y12受体拮抗剂是急性冠脉综合征患者抗血小板治疗的基础[3]。在亚洲人群中患者存在CYP2C19基因多态性导致对氯吡格雷抵抗或低反应；对于经皮冠状动脉介入治疗（PCI）术后氯吡格雷抵抗的患者，临床上常加大氯吡格雷剂量或联用西洛他唑，效果并不理想[4]。替……