《中国康复理论与实践》

《中国康复理论与实践》 ›› 2009, Vol. 15 ›› Issue (01): 76-78.

• 临床研究 • 上一篇    下一篇

急性冠脉综合征患者服用氯吡格雷临床预后分析

敖强国;张丽萍;李健;王磊;盛莉   

  1. 解放军总医院老年肾内科，北京市 100853
  • 收稿日期:2008-11-10 出版日期:2009-01-01 发布日期:2009-01-01

Outcomes of Clopidogrel for Patients with Acute Coronary Syndrome

AO Qiang-guo, ZHANG Li-ping, LI Jian, et al   

  1. Department of Geriatric Nephrology, General Hospital of PLA, Beijing 100853, China
  • Received:2008-11-10 Published:2009-01-01 Online:2009-01-01

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摘要： 目的 对比分析急性冠脉综合征（ACS）患者采用不同抗血小板治疗方案对临床预后的影响。方法 回顾性分析338例ACS患者，其中93例患者在出院时单用阿司匹林（阿司匹林组）；245例患者在出院时联合应用阿司匹林和氯吡格雷，其中127例患者6～12月后停用氯吡格雷（二联1年组），其余118例患者继续长期联合服用氯吡格雷和阿司匹林（二联2年组）。平均随访24个月，观察各组出院后1年、2年时一级终点（心血管性死亡、非致死性心肌梗死及卒中）和出血（主要出血、次要出血、轻微出血）的发生率。同时对各组临床资料，首次治疗前、1年时及2年时血小板、血脂指标进行比较。结果 出院后1年时和2年时，与阿司匹林组比较，二联1年组和二联2年组患者心血管死亡率和一级联合终点降低（均P＜0.05），非致死性心肌梗死和卒中的发生率无显著性差异（P＞0.05）。二联1年组与二联2年组比较,心血管死亡、非致死性心肌梗死、卒中发生率和联合终点均无显著性差异（P＞0.05）。主要出血、次要出血、轻微出血，各组间比较无显著性差别（P＞0.05）。结论 长期联合阿司匹林和氯吡格雷抗血小板治疗有进一步降低ACS患者2年时心血管死亡率趋势，不增加严重出血风险。

关键词: 急性冠脉综合征, 氯吡格雷, 血小板

Abstract: Objective To compare the effects of different antiplatelet therapy on outcomes in patients with acute coronary syndrome (ACS). Methods 338 hospitalized patients with ACS were enrolled. They were assigned to three groups: group 1, aspirin alone after discharge, n=93; group 2, dual antiplatelet treatment of aspirin and clopidogrel after discharge for 6～12 months, then aspirin, n=127; and group 3, dual antiplatelet treatment of aspirin and clopidogrel after discharge for 2 years, n=118. All the patients were followed up for 2 years. The clinical data (basic clinical data, platelet count and serum lipids indeices), primary end point (cardiovascular death, nonfatal myocardial infarction and stroke) and hemorrhagic events (major hemorrhage, moderate hemorrhage and minor hemorrhage) within 1 and 2 years were analyzed. Results During 1 and 2 years, compared with group 1, the incidence of cardiovascular death and all primary end points of groups 2 and 3 decreased significantly (P＜0.05), but the nonfatal myocardial infarction and stroke did not （P＞0.05）. The difference was not statistically significant between groups 2 and 3 in all the end points （P＞0.05）. The difference of hemorrhagic events was not statistically significant among the 3 groups（P＞0.05）. Conclusion Dual antiplatelet treatment of clopidogrel plus aspirin for 2 years may decrease the mortality of cardiovascular disease while the incidence of severe hemorrhage doesn't increase.

Key words: acute coronary syndrome, clopidogrel, platelet