不同剂量替格瑞洛对老年急性冠状动脉综合征合并中度肾功能不全患者疗效及肾功能的影响
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(1.郑州煤炭工业(集团)有限责任公司总医院内二病区,河南省郑州市 452370;2.新乡医学院临床医学系,河南省新乡市 453000)

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云礼强,主治医师,研究方向为冠心病,E-mail为yunliqiangzz@163.com。

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Effect of different dosages of ticagrelor on the efficacy and renal function in elderly patients with acute coronary syndrome combined with moderate renal insufficiency
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1.Internal Medicine 2, the General Hospital of Zhengzhou Coal Industry (Group) Limited Liability Company, Zhengzhou 452370, Henan, China;2.Department of Clinical Medicine, Xinxiang Medical College, Xinxiang 453000, Henan, China)

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    摘要:

    目的 探讨不同剂量替格瑞洛对老年(>70岁)急性冠状动脉综合征(ACS)合并中度肾功能不全(CRI)患者疗效及肾功能的影响。 方法 将72例老年ACS合并中度CRI患者按照数字表法随机分为全量组(36例)和半量组(36例),在原有冠心病、肾功能不全常规治疗的基础上,全量组采用替格瑞洛全量治疗(180 mg负荷量后,再以90 mg/次,2次/天);半量组采用替格瑞洛半量治疗(90 mg负荷量后,再以45 mg/次,2次/天)。于分组治疗前及治疗后1个月、3个月、6个月、12个月分别检测血小板抑制率(PIR)、血清肌酐(Scr)及丙氨酸氨基转移酶(ALT),计算估算的肾小球滤过率(eGFR),观察两组治疗12个月内的缺血事件、出血事件及药物的不良反应。 结果 治疗1个月、3个月、6个月、12个月后,两组患者PIR、Scr较治疗前呈升高趋势,eGFR较治疗前呈下降趋势。两组患者PIR比较差异无统计学意义(F=3.679,P=0.059);半量组患者Scr和ALT低于全量组(F=234.288、19.451,P=0.000、0.000),eGFR高于于全量组(F=54.521,P=0.000)。用药12个月内随访:两组缺血事件发生率比较差异无统计学意义(χ2=0.050,P=0.824),半量组出血事件发生率和呼吸困难发生率低于全量组(χ2=5.188、5.030,P=0.023、0.025)。 结论 对于老年急性冠状动脉综合征合并中度肾功能不全患者,应用半量与全量替格瑞洛时其PIR无显著差异,疗效相当,但半量替格瑞洛对肾功能及肝功能的影响较小,出血率较低,安全性更好。

    Abstract:

    Aim To study the effect of different dosages of ticagrelor on the efficacy and renal function in elderly (>70 years) patients with acute coronary syndrome (ACS) combined with moderate chronic renal insufficiency (CRI). Methods 72 patients with ACS and CRI were randomly divided into full-dose group (36 cases) and half-dose group (36 cases). On the basis of routine treatment of the coronary heart disease and renal insufficiency, patients in full-dose group were treated with full-dose ticagrelor (loading dose 180 mg, followed by 90 mg/times, 2 times/day); patients in half-dose group were treated with half-dose ticagrelor (loading dose 90 mg, followed by 45 mg/times, 2 times/day). The platelet inhibition rate (PIR), serum creatinine (Scr) and alanine aminotransferase (ALT) were detected and the estimated glomerular filtration rate (eGFR) was calculated in the two groups before treatment, after treatment 1,3, 6,2 months, the ischemic events, bleeding events and drug adverse reaction were followed up after treatment within 12 months. ResultsAfter treatment for 1 months, 3 months, 6 months and 12 months, the PIR and Scr in the two groups had an increased trend and the eGFR had a decreased trend compared with before treatment. There was no significant difference in PIR between the two groups (F=3.679, P=0.059), Scr and ALT in the half-dose group was significantly lower than those in the full-dose group (F=234.8,9.451, P=0.0,0.000), eGFR in the half-dose group was significantly higher than that in the full-dose group (F=54.521, P=0.000). After 12 months of follow-up, there was no significant difference in the incidence of ischemic events between the two groups (χ2=0.050, P=0.824), incidence of bleeding events and incidence of dyspnea in the half-dose group were lower than those in the full-dose group (χ2=5.8,5.030, P=0.3,0.025). Conclusion For elderly patients with ACS and moderate renal insufficiency, there is no significant difference in PIR value between half-dose and full-dose of ticagrelor, but the effect of half-dose of ticagrelor on renal function and liver function is less, bleeding rate is low, and safety is better.

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云礼强,杨世文,刘晓峰,姚颖府,崔书菻.不同剂量替格瑞洛对老年急性冠状动脉综合征合并中度肾功能不全患者疗效及肾功能的影响[J].中国动脉硬化杂志,2018,26(2):181~185.

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  • 收稿日期:2017-06-30
  • 最后修改日期:2017-07-25
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  • 在线发布日期: 2018-03-07