2018 年第 1 期 第 13 卷

糖尿病患者择期冠状动脉介入术中应用小剂量普通肝素联合依诺肝素序贯抗凝的安全性和有效性研究

作者：候雪见李志忠王苏程宇彤孙涛黄觊

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科

英文单位：

关键词：糖尿病；经皮冠状动脉介入；普通肝素；依诺肝素

英文关键词：

• 摘要：

• 【摘要】目的    探讨糖尿病患者在接受择期经皮冠状动脉介入(PCI)术中应用小剂量普通肝素联合依诺肝素序贯抗凝的安全性和有效性。方法    连续选取2015年6月至2016年6月在首都医科大学附属北京安贞医院心内科诊断为稳定型心绞痛或不稳定型心绞痛接受择期PCI治疗的糖尿病患者共490例，完全随机分为2组，造影前均导管内推注普通肝素3 000 U，小剂量普通肝素-依诺肝素序贯抗凝组(观察组)249例，行PCI时导管内补充依诺肝素0.75 mg/kg；普通肝素组(对照组)241例，导管内补充普通肝素至总量(含造影时用量)100 U/kg。比较2组患者术后30 d和1年主要心血管不良事件 (包括全因死亡、再发心肌梗死、靶血管紧急血运重建)发生情况。结果    2组患者术后30 d和1年内均无主要心血管不良事件事件发生；术后30 d内和术后1年再发心绞痛和再住院率观察组与对照组比较差异均无统计学意义［2.8%（7/249）比2.1%（5/241）;11.6%(29/249)比9.1%(22/241)］(均P>0.05)，调整混杂因素后2组比较差异仍无统计学意义(比值比=1.32，95%置信区间：0.75~2.30，P=0.33)。结论    糖尿病合并稳定型心绞痛或不稳定型心绞痛患者择期PCI术中应用小剂量普通肝素联合依诺肝素序贯抗凝与普通肝素相比同样安全及有效。

• Effectiveness and safety of low dose unfractionated heparin combined with sequential enoxaparin on diabetic patients undergoing elective percutaneous coronary intervention

  Hou Xuejian, Li Zhizhong, Wang Su, Cheng Yutong, Sun Tao, Huang Ji

  Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

  Corresponding author: Li Zhizhong, Email: lzzeagle@sina.com

  【Abstract】Objective     To explore the effectiveness and safety of low dose unfractionated heparin(UFH) combined with sequential enoxaparin on diabetic patients undergoing elective percutaneous coronary intervention(PCI). Methods    A total of 490 diabetic patients who were diagnosed of stable or unstable angina undergoing PCI from June 2015 to June 2016 in the 5th Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University were randomly assigned to have UFH with sequential enoxaparin(experimental group, n=249) and routine UFH(control group, n=241). Patients in both groups were administered 3 000 U UFH before coronary angiography; the experimental group was administered enoxaparin 0.75 mg/kg and the control group was added UFH to a total dose of 100 U/kg before PCI. Incidences of major adverse cardiac events(MACE) including all-cause mortality, recurrent myocardial infarction and target vessel revascularization in 30 d and 1 year after PCI were analyzed. Results    No MACE occurred in 30 d and 1 year after PCI in both groups. The 30 d and 1 year recurrent angina and rehospitalization rates had no significant differences between experimental group and control group［2.8%（7/249） vs 2.1（5/241）, 11.6%(29/249) vs 9.1%(22/241)］(P>0.05), and the recurrent angina and rehospitalization rate showed no significant difference between groups in further analysis based on confounding factors adjustment(odds ratio=1.32, 95% confidence interval: 0.75-2.30, P=0.33). Conclusion    UFH with sequential enoxaparin may be as effective and safe as the standard UFH anticoagulant therapy in elective PCI for diabetic patients with stable or unstable angina.

  【Key words】Diabetes mellitus;Percutaneous coronary intervention;Unfractionated heparin;Enoxaparin

  【Fund program】Clinical Characteristic Application Research of the Capital(Z131107002213042); Beijing Lab for Cardiovascular Disease Precision Medicine, Beijing, China(PXM2017_014226_000037)