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目的观察替格瑞洛对保守治疗的高龄急性冠脉综合征患者临床疗效及其对炎症水平影响。方法选取2014年1-12月在邢台市第三医院心内科住院且年龄>75岁行保守治疗的急性冠脉综合征患者60例,随机分为替格瑞洛组和氯吡格雷组,每组30例。随访6个月,观察两组患者心绞痛发作、再发急性心肌梗死、反复住院、心血管死亡、轻度出血、大出血、缓慢心律失常、呼吸困难等发生情况;分别于治疗前、治疗后1和6个月抽取血浆测试正五聚素3(PTX3)。结果治疗6个月后,替格瑞洛组平均每天心绞痛发作次数、平均每次发作持续时间及反复住院率均低于氯吡格雷组(P<0.05),轻度出血高于氯吡格雷组(P<0.05),PTX3水平较氯吡格雷组降低(P<0.05)。而严重出血、缓慢心律失常、呼吸困难两组间比较差异无统计学意义(P>0.05)。结论替格瑞洛可明显降低高龄急性冠脉综合征患者心绞痛发作及反复住院率,且能抑制患者体内炎症水平,大出血发生率无增加。
Objective To observe the clinical effect of ticagrelor in conservative treatment of elderly patients with acute coronary syndrome and its effect on the level of inflammation. Methods Sixty patients with acute coronary syndrome who were hospitalized in the department of cardiology of the Third Hospital of Xingtai City from January to December 2014 and were conservatively treated at the age of 75 years were randomly divided into ticagrelor group and clopidogrel group. Group of 30 cases. The patients were followed up for 6 months. Angina attack, recurrent acute myocardial infarction, recurrent hospitalization, cardiovascular death, mild bleeding, haemorrhage, bradyarrhythmia and dyspnea were observed. Plasma samples were taken at 6 months for pentagostatin 3 (PTX3). Results After 6 months of treatment, the average daily incidence of angina attacks, the average duration of each episode and the rate of repeated hospitalization in the ticagrelor group were lower than those in the clopidogrel group (P <0.05), mild bleeding was higher than that in the clopidogrel group (P <0.05), PTX3 level was lower than that of clopidogrel group (P <0.05). The severe bleeding, slow arrhythmia, dyspnea were no significant difference between the two groups (P> 0.05). Conclusion Ticagrelor can significantly reduce the incidence of angina pectoris and repeated hospitalization in elderly patients with acute coronary syndrome, and can inhibit the level of inflammation in patients with no increase in the incidence of major bleeding.