替罗非班对糖尿病中危非ST段升高型急性冠脉综合征超敏C反应蛋白和纤维蛋白原的影响

目的:探讨盐酸替罗非班对糖尿病中危非ST段升高急性冠脉综合征（ACS）患者超敏C反应蛋白（hs-CRP）和纤维蛋白原（FIB）的影响。方法:选择住院非ST段升高的ACS患者248例,其中观察组129例,对照组119例,所有患者均首剂服用阿司匹林300 mg、氯吡格雷300 mg,之后阿司匹林100 mg/d、氯吡格雷75 mg/d,在此基础上观察组患者给予静脉输注盐酸替罗非班2～3 d,给予替罗非班期间连用皮下注射低分子肝素（依诺肝素:40 mg/12 h）,停止注射盐酸替罗非班12 h后,继续皮下注射低分子肝素3～4 d[依诺肝素:1 mg/（kg.12h）];对照组患者用低分子肝素[依诺肝素:1 mg/（kg.12h）]皮下注射连续使用5～7 d。测定患者治疗前、治疗后7、30和60 d血浆hs-CRP和FIB并分析其相关性;观察两组中治疗后30 d、60 d内死亡、非致死性心肌梗死、复发性胸痛例数;出血状况。结果:通过治疗两组hs-CRP和FIB水平均逐渐下降。观察组于治疗后7 d hs-CRP和FIB水平开始低于对照组,30 d降低作用最显著,60 d两组hs-CRP和FIB水平差异消失;两组hs-CRP和FIB水平变化呈线性正相关;观察组30 d和60 d的复合缺血事件明显低于对照组;两组临床均无无明显出血事件发生。结论:替罗非班可进一步降低中危ACS伴糖尿病患者的hs-CRP和FIB水平;降低复合缺血事件发生的同时并不增加临床出血事件发生。

Effects of tirofiban on high-sensitivity C-reactive protein and fibrinogen in non-ST-segment elevation acute coronary syndrome patients with medium-risk diabetes

AIM:To explore effects of tirofiban on high-sensitivity C-reactive protein(hs-CRP) and fibrinogen(FIB) in non-ST-segment elevation acute coronary syndromes(STE ACS) patients with medium risk diabetes.METHODS:A total of 248 cases of hospital patients with non-STE ACS were assigned to two groups:129 cases in observation group and 119 cases in control group.Aspirin(300 mg) and clopidogrel(300 mg) were given as initial dose and afterwards aspirin(100 mg/day) and clopidogrel(75 mg/day) as treatment dose.In observation group,tirofiban was additionally given IVI for 2-3 days,together with hypodermic injection of low molecular weight heparin(LMWH)(enoxaparin) 40 mg/12 h.Twelve hours after tirofiban injection suspension,hypodermic injection of LMWH alone was given for another 3-4 days.In control group,hypodermic injection of LMWH [enoxaparin 1 mg/(kg·12 h)] was given for 5-7 days.Patients’ plasma hs-CRP,FIB and correlation were also examined before and 7,30 and 60 days after treatment.Deaths,nonfatal MI,recurrent chest pain and bleeding conditions were also observed 30 and 60 days after treatment.RESULTS:hs-CRP and FIB levels decreased in both groups.hs-CRP and FIB levels in observation group became lower than those in control group 7 days after treatment.This difference was most significant 30 days after treatment but disappeared 60 days after treatment.hs-CRP and FIB levels in both groups presented a linear positive correlation.Composite ischemic event incidence in observation group was lower than that in control group 30 and 60 days after treatment and no major bleeding events occurred in either group.CONCLUSION:Tirofiban further reduces hs-CRP and FIB levels and lowers composite ischemic event and major bleeding events in non-STE ACS patients with medium-risk diabetes.