【摘要】 目的评估氯比格雷(Clopidogrel)与阿司匹林(Aspirin)对急性心肌梗死(acute myocardial infarc-tion,AMI)临床和血小板聚集性的影响。方法97例AMI患者被随机分为治疗组48例联用氯比格雷与阿司匹林和对照组49例单用阿司匹林治疗4周。观察复发心绞痛、心功能改善程度、死亡率等临床指标。治疗前后心电图梗死部位ST段、血小板最大聚集率及血液肝肾功能、白细胞、血小板和出、凝血时间等有关指标变化,行统计学分析。结果再发心绞痛治疗组∶对照组为10%∶20%;心功能改善的总频数为36·7%∶22·4,χ2=3·638,P=0·045;死亡率为4%∶8%。心电图梗死部位ST段治疗组由(0·36±0·13)mV降为(0·13±0·08)mV,对照组由(0·35±0·14)mV降为(0·16±0·90)mV,两组比较,t=3·012,P=0·04。腺苷(ADP)诱导血小板聚集率治疗组由(74·54±8·99)%降至(34·09±9·23)%,对照组由(72·30±7·78)%降至(56·54±6·92)%,两组比较,t=13·42,P<0·001。胶原(Coll)诱导血小板聚集率治疗组(82·09±6·31)%降至(77·20±6·17)%,t=3·949,P<0·001,对照组差异不显著(t=1·93,P=0·06)。两组均少见大出血、血小板减少性紫癜等严重副作用。结论AMI患者存在血小板聚集性增强,联用氯比格雷治疗能减少再发心绞痛、改善心功能、减少死亡率,改善心肌的再灌注,进一步抑制血小板的聚集性。更多还原

【Abstract】 Objective To investigate the effect of combined antiplatelet drugs on clinic and aggregation activity of platelet in patient with aucte myocardial infarction(AMI).Methods Consecutive 97 cases with AMI were redomized to receive clopidogrel plus aspirin(treated group,n=48) or aspirin alone(placebo group,n=49) for 30 days.Before and after treatment,the clinical recurrent angina,improvement of heart function,death,ST segment changes of electrocardiogram and the rate of maximun aggregation of paltelet were tested and analysed.Results Recurrent angina occurred in 10.0%(5 cases) in the treated group and 20%(10 cases) in the placebo group.The total frequency of improvement of heart function occurred in 36.7%(18 cases) in the treated group and 22.4%(11 cases) in the placebo group(χ~2=3.638,P=0.045).Death occurred in 4%(2 cases) in the treated group and 8%(4 cases) in the placebo group.ST segment of electrocardiogram decreased from (0.36±0.13)mV to (0.13±0.08)mV,compared with placebo from (0.35±0.14)mV to (0.16±0.90)mV(t=3.012,P=0.04).The rate of maximum aggregation of platelet induced by ADP reduced from (74.54±8.99)% to (34.09±9.23)%,the placebo from (72.30±7.78)% to (56.54±6.92)%(t=13.42,P<0.001) by Coll from (82.09±6.31)% to (77.20±6.17)% in treated group(t=3.949,P<0.001),there was no significance in placebo(t=1.93,P=0.06).There were few severe bleeding and thombocytopenic purpura,neither treated nor placebo group.Conclusions The conbined clopidogrel plus aspirin may reduce the risk of a serious cardiovascular event in patient with AMI,such as recurrent angina,death,improvement of heart function and it may improve the reperfusion of the coronary artery,inhibit the activity of plastelet,reduce the rate of maximum aggregation of platelet.更多还原