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目的探讨半剂量替格瑞洛在高龄(>75岁)冠脉综合征(ACS)并发肾功能不全(CRI)患者中的远期疗效及安全性。方法入选ACS并发CRI的患者93例,分为替格瑞洛全剂量组(n=48例)及半剂量组(n=45)。全剂量组替格瑞洛负荷剂量180 mg,随之90 mg,2次/d,半剂量组负荷剂量90 mg,随之45 mg,2次/d。进行记录及临床随访12个月,比较两组患者主要不良心脑血管事件(MACCE))的发生率,出血事件的发生率,及其他不良反应的发生率。结果两组患者在基线临床资料如年龄、性别、吸烟史、高脂血症、高血压病、肝功能、左室射血分数(LVEF)及肾小球滤过率估计值(e GFR)等均无显著差异,而糖尿病患病率及ST抬高型ACS(STEACS)的发生率在两组之间有显著差异(P<0.05)。随访12个月发现,全剂量组和半剂量组的MACCE事件分别发生9例(19%)和6例(13%),两组之间差异无统计学意义。全剂量组和半剂量组出血事件分别发生16例(33%)和6例(13%),均为轻度出血,半剂量组出血事件显著少于全剂量组,有显著性统计学差异(P<0.05),无严重或者致死性出血的发生。呼吸困难在全剂量组和半剂量组的发生率分别为12例(25%)和9例(20%),呼吸困难均是轻度、可耐受、一过性的,两组之间无显著性统计学差异。结论半剂量的替格瑞洛对于高龄(>75岁)ACS并发CRI患者中和全剂量替格瑞洛有同样的疗效,并且有较好的安全性。
Objective To investigate the long-term efficacy and safety of half-dose ticagrelor in elderly patients (> 75 years) with coronary syndrome (ACS) complicated with renal insufficiency (CRI). Methods A total of 93 patients with ACS complicated with CRI were divided into ticagrelor group (n = 48) and semi-dose group (n = 45). In the full dose group, the ticagrelor loading dose was 180 mg followed by 90 mg twice daily and the half dose dose was 90 mg followed by 45 mg twice daily. The records were followed up for 12 months. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE), the incidence of bleeding events, and other adverse reactions were compared between the two groups. Results The two groups of patients at baseline clinical data such as age, gender, smoking history, hyperlipidemia, hypertension, liver function, left ventricular ejection fraction (LVEF) and glomerular filtration rate estimates (e GFR) There was no significant difference between the two groups. However, the prevalence of diabetes and the incidence of ST-elevation ACS (STEACS) were significantly different between the two groups (P <0.05). At follow-up of 12 months, MACCE events occurred in 9 cases (19%) and 6 cases (13%) in the whole dose group and the half dose group, respectively. There was no significant difference between the two groups. Bleeding events occurred in 16 patients (33%) and 6 patients (13%) in the whole dose group and in the half dose group, all of which were mild hemorrhage. The bleeding events in the half dose group were significantly less than those in the full dose group, with significant statistical difference P <0.05), no serious or fatal bleeding occurred. The incidence of dyspnea was 12 (25%) and 9 (20%) in the full-dose and half-dose groups, respectively, and the dyspnea was mild, tolerable and transient in both groups Significant statistical difference. Conclusion Ticagrelor at half dose has the same effect on ticagrelor in patients with ACS and CRI in elderly patients (> 75 years old) and has good safety.