2018 年第 3 期 第 13 卷

氯吡格雷应用于药物洗脱支架置入术后冠状动脉粥样硬化性心脏病患者的临床疗效

Clinical effect of clopidogrel on coronary heart disease patients after drug-eluting stent implantation

作者：张伟陆士娟钟江华

英文作者：

单位：570208海口市人民医院心内科

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• 摘要：

• 目的    探讨氯吡格雷应用于药物洗脱支架置入术后冠状动脉粥样硬化性心脏病(冠心病)患者的临床疗效。方法    回顾性分析2014年12月至2016年12月在海口市人民医院接受经皮冠状动脉介入治疗的148例稳定型冠心病患者的临床资料。依据治疗方法不同分为对照组（支架置入术后服用氯吡格雷3个月）和观察组（支架置入术后服用氯吡格雷6个月），各74例。比较2组随访6个月内的重大临床不良事件（急性心血管事件、再次住院、血栓形成）发生率及病死率，治疗前和治疗6个月后的血脂及血液流变学指标。结果    观察组急性心血管事件发生率、再次住院率、血栓发生率均低于对照组［6.8%（5/74）比14.9%（11/74）、8.1%（6/74）比18.9%（14/74）、4.0%（3/74）比9.5%（7/74）］，差异均有统计学意义（均P＜0.05）。2组患者均无死亡。治疗6个月后2组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、低切全血黏度、高切全血黏度、血浆黏度均明显低于治疗前，高密度脂蛋白胆固醇明显高于治疗前［观察组：（1.8±0.9）mmol/L比（4.3±1.0）mmol/L、（0.9±0.8）mmol/L比（1.6±0.8）mmol/L、（1.3±0.8）mmol/L比（2.6±0.9）mmol/L、（6.8±0.6）mPa·s比（10.8±0.7）mPa·s、（4.0±0.4）mPa·s比（6.4±0.5）mPa·s、（0.93±0.26）mPa·s比（1.74±0.31）mPa·s、（1.22±0.24）mmol/L比（1.02±0.32）mmol/L，对照组：（3.6±0.9）mmol/L比（4.2±1.0）mmol/L、（1.3±0.8）mmol/L比（1.6±1.0）mmol/L、（2.0±0.8）mmol/L比（2.6±0.9）mmol/L、（8.3±0.7）mPa·s比（10.8±0.7）mPa·s、（4.7±0.3）mPa·s比（6.5±0.4）mPa·s、（1.24±0.35）mPa·s比（1.73±0.29）mPa·s、（1.10±0.31）mmol/L比（0.99±0.27）mmol/L］，且观察组改善程度大于对照组，差异均有统计学意义（均P＜0.05）。结论    氯吡格雷维持治疗6个月对行药物洗脱支架置入术后冠心病患者效果显著，能够改善患者血脂水平和血液流变学指标，预后良好。

• Objective    To investigate the clinical effect of clopidogrel on coronary heart disease patients after drug-eluting stent implantation. Methods    Clinical records of 148 patients with stable coronary heart disease who had percutaneous coronary intervention from December 2014 to  December 2016 in Haikou People′s Hospital were retrospectively analyzed. According to different postoperative antiplatelet treatments, the patients were divided into control group and observation group, with 74 cases in each group. The control group took clopidogrel for 3 months and the observation group took clopidogrel for 6 months after coronary intervention. All patients were followed for 6 months, incidence rates of major adverse events including acute cardiovascular events, rehospitalization, thrombosis and the mortality rate were recorded. Blood lipid and hemorheologic indexes were analyzed before and 6 months after treatment. Results    Incidences of acute cardiovascular events, rehospitalization and thrombosis in observation group were significantly lower than those in control group［6.8%（5/74） vs 14.9%（11/74）, 8.1%（6/74） vs 18.9%（14/74）, 4.0%（3/74） vs 9.5%（7/74）］(P<0.05). No death occurred in both groups. After 6 months of treatment, levels of total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, low-shear blood viscosity, high-shear blood viscosity, plasma viscosity were significantly lower and high-density lipoprotein cholesterol was significantly higher than those before treatment in both groups［observation group： （1.8±0.9）mmol/L vs （4.3±1.0）mmol/L, （0.9±0.8）mmol/L vs （1.6±0.8）mmol/L, （1.3±0.8）mmol/L vs （2.6±0.9）mmol/L, （6.8±0.6）mPa·s vs （10.8±0.7）mPa·s, （4.0±0.4）mPa·s vs （6.4±0.5）mPa·s, （0.93±0.26）mPa·s vs （1.74±0.31）mPa·s, （1.22±0.24）mmol/L vs （1.02±0.32）mmol/L； control group： （3.6±0.9）mmol/L vs （4.2±1.0）mmol/L, （1.3±0.8）mmol/L vs （1.6±1.0）mmol/L, （2.0±0.8）mmol/L vs （2.6±0.9）mmol/L, （8.3±0.7）mPa·s vs （10.8±0.7）mPa·s, （4.7±0.3）mPa·s vs （6.5±0.4）mPa·s, （1.24±0.35）mPa·s vs （1.73±0.29）mPa·s, （1.10±0.31）mmol/L vs （0.99±0.27）mmol/L］, and there were significant differences between groups(P<0.05). Conclusions    ix months treatment of clopidogrel can effectively improve blood lipid level, hemorheologic indexes and the prognosis in coronary heart disease patients after stent implantation.