替格瑞洛治疗非ST段抬高型急性冠脉综合征合并慢性阻塞性肺疾病患者的效果

Efficacy of ticagrelor in treatment of non-ST-segment elevation acute coronary syndrome patients accompanied with chronic obstructive pulmonary disease

摘要:

目的 探讨替格瑞洛对非ST段抬高型急性冠脉综合征(NSTE-ACS)合并慢性阻塞性肺疾病(COPD)患者的疗效和安全性。方法 回顾性分析2018年1月至11月陕西省第四人民医院心血管内科NSTE-ACS合并COPD患者194例,根据使用抗血小板药物情况分为替格瑞洛组96例和氯吡格雷组98例。患者选择性行经皮冠状动脉介入(PCI)术,替格瑞洛组患者术前给予负荷剂量180mg,术后和未手术给予90mg,2次/d,氯吡格雷组患者术前给予负荷剂量300mg,术后和未手术给予75mg,2次/d,服药1个月后比较呼吸困难临床症状和改良版英国医学研究会呼吸困难量表(mMRC)评分,肺功能指标第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1占预计值百分比(FEV1% pred)和FEV1/FVC。随访6个月后比较2组患者主要不良心脑血管事件(MACCE)和出血事件发生率。应用SPSS 22.0统计软件对数据进行分析。根据数据类型采用t检验或χ²检验进行组间比较。结果 2组患者年龄、性别、体质量指数、高血压、糖尿病、高脂血症、不稳定性心绞痛、行PCI术比例等差异无统计学意义(P＞0.05)。服药1个月后替格瑞洛组相比氯吡格雷组患者呼吸困难临床症状评分[(2.2±0.6)和(1.4±0.8)分]、mMRC评分[(3.4±0.5)和(2.9±0.9)分]、FEV1/FVC[(75.7±4.6)%和(71.0±9.2)%]和FEV1% pred[(69.1±6.6)%和(67.6±5.9)%]差异无统计学意义(P＞0.05)。随访6个月后替格瑞洛组相比氯吡格雷组患者MACCE发生率[5.2%(5/96)和12.2%(12/98),P=0.043]显著降低,且出血事件发生率[19.8%(19/96)和10.2%(10/98),P=0.061]差异无统计学意义。结论 替格瑞洛不影响NSTE-ACS合并COPD患者肺通气功能,可有效降低短期MACCE发生风险,且出血事件发生率不增高。

Abstract:

Objective To investigate the efficacy and safety of ticagrelor in the treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients accompanied with obstructive pulmonary disease (COPD). Methods A retrospective analysis was made on 194 cases of NSTE-ACS combined with COPD from January to November 2018 in the Department of Cardiology of the Fourth People′s Hospital of Shaanxi Province. According to the usage of antiplatelet drugs, they were divided into ticagrelor group (n=96) and clopidogrel group (n=98). All of them underwent elective percutaneous coronary intervention (PCI). The patients of the ticagrelor group were given at a loading dose of 180 mg preoperatively, and at 90 mg, twice a day post-operatively or to those non-operative patients. While, those of clopidogrel group were given 300 mg preoperatively, 75 mg, twice a day post-operatively, and 75mg to the non-operative patients. In 1 month after administration, improvement of dyspnea, score of British Medical Research Council Scale (mMRC), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), percentage of FEV1 to the predicted value (FEV1% pred) and FEV1/FVC were evaluated and compared between the 2 groups. The incidence of major adverse cardio-cerebrovascular events (MACCE) and bleeding events were also compared after 6 months of follow-up. SPSS statistics 22.0 was used for data analysis. Student′s t test or Chi-square test was applied to make comparison between 2 groups according to the different data types. Results There were no significant differences in age, gender, body mass index, hypertension, diabetes, hyperlipidemia,unstable angina pectoris and proportion of patients undergoing PCI between the 2 groups (P>0.05). One month later, no significant differences were found in the score of clinical dyspnea symptoms (2.2±0.6 vs 1.4±0.8), mMRC score (3.4±0.5 vs 2.9±0.9), FEV1/FVC [(75.7±4.6)% vs (71.0±9.2)%] and FEV1% pred [(69.1±6.6)% vs (67.6±5.9)%] between the clopidogrel group and the ticagrelor group (P>0.05). After 6 months of follow-up, the incidence of MACCE was significantly lower in the ticagrelor group than the clopidogrel group [5.2%(5/96) vs 12.2%(12/98), P=0.043], but no difference was seen in that of bleeding events [19.8%(19/96) vs 10.2%(10/98), P=0.061]. Conclusion Ticagrelor does not affect the pulmonary ventilation function in patients with NSTE-ACS and COPD, and effectively reduces the risk of short-term MACCE, and has no effect on the incidence of bleeding events.