冠心病患者替格瑞洛相关呼吸困难并发症发生的临床分析

Clinical analysis of ticagrelor-related dyspnea in coronary artery disease patients

摘要:

目的 在冠心病（CAD）患者中分析与替格瑞洛呼吸困难有关的影响因素，及该并发症对患者的替格瑞洛依从性和预后的影响。方法 募集2014年1月至2015年2月于解放军总医院心内科接受替格瑞洛治疗的CAD患者。统计患者院内及出院6个月替格瑞洛相关呼吸困难的发生情况，分析该并发症的影响因素。通过6个月随访观察，在持续服用替格瑞洛的患者中，分析替格瑞洛相关呼吸困难的发生对联合缺血和出血终点事件的影响。结果 共募集647例CAD患者。6个月内，发生替格瑞洛相关呼吸困难85例（13.14%），其中43例发生在1周内，35例发生在1个月内，7例发生在1个月后。因呼吸困难停用替格瑞洛者15例。多因素相关分析发现，患者合用替罗非班发生替格瑞洛相关呼吸困难的风险增加（OR：2.45，95%CI：1.41～4.27，P＝0.001），而合用他汀类药物（OR：0.20，95%CI：0.04～0.92，P＝0.04）、或质子泵抑制剂（OR：0.56，95% CI：0.32～0.97，P＝0.04）发生替格瑞洛相关呼吸困难的风险降低。对6个月随访期内持续服用替格瑞洛的患者（353例）分析发现，联合缺血和出血终点事件在替格瑞洛相关呼吸困难者与未发生者之间无显著性差异。结论 CAD患者中替格瑞洛相关呼吸困难多见于服药1个月内，合并用药可能是影响替格瑞洛相关呼吸困难发生的主要相关因素。替格瑞洛相关呼吸困难的发生会影响患者的依从性，但可能不影响患者的预后。

Abstract:

Objective To determine the influencing factors associated with ticagrelor-related dyspnea in the patients with coronary artery diseases (CAD), and investigate the impact of the side effect on compliance and clinical outcomes of ticagrelor treatment. Methods Consecutive CAD patients treated by ticagrelor in our department from January 2014 to February 2015 were recruited in this study. The in- and out-hospital incidence of ticagrelor-related dyspnea was recorded in 6-month follow-up, and the influencing factors for the side effect were analyzed by multivariate regression analysis. The influence of ticagrelor-related dyspnea on the occurrence of ischemic and bleeding events was observed during the 6 months’ follow-up. Results There were 647 CAD patients recruited in this study, and ticagrelor-related dyspnea was found in 85 patients (13.14%). The side effect was observed in 43 patients within 1 week after ticagrelor treatment, 35 patients within 1 month, and 7 patients after 1 month. Cessation of its administration was in 15 patients due to ticagrelor-related dyspnea. Concomitant therapy with tirofiban was associated with higher risk of ticagrelor-related dyspnea (OR＝2.45, 95%CI: 1.41?4.27, P＝0.001), while concomitant therapy with statins (OR＝0.20, 95%CI: 0.04?0.92, P＝0.04) and proton pump inhibitors (PPI; OR＝0.56, 95%CI: 0.32?0.97, P＝0.04) were with lower risk of the effect. For the patients (n＝353) continuously taking ticagrelor in the follow-up period, no significant difference was seen in the occurrences of ischemic and bleeding events between those with ticagrelor-related dyspnea and those without. Conclusion The side effect of ticagrelor-related dyspnea usually occurs within 1 month after ticagrelor treatment in CAD patients. Co-medication may be the main relevant factor influencing the occurrence. Ticagrelor-related dyspnea impacts the compliance of ticagrelor, but may have no effect on the clinical prognosis.