替罗非班对非ST段抬高急性冠脉综合征的治疗作用

目的观察盐酸替罗非班对非ST段抬高急性冠脉综合征患者血小板聚集率、血清sCD40L及高敏C反应蛋白（hs-CRP）水平的影响，并随访30d主要心血管事件。方法入选80例高危非ST段抬高急性冠脉综合征患者，所有入选患者随机分为两组：替罗非班组（40例）在接受常规治疗的基础上联合应用盐酸替罗非班，首先给予负荷量0．4μg／（kg·min）持续30min，继而给予维持量0．1μg／（kg·min）连续静脉滴注48h；常规治疗组（40例）仅接受常规药物治疗。于用药前和持续用药48h后，分别测定血小板聚集率、血清sCD40L和hs—CRP水平。结果常规治疗组与替罗非班组在持续用药48h后，血小板聚集率分别为（36．27±15．89）％、（9．04±6．16）％，与基线（49．88±11．81）％、（47．73±10．31）％比较均有下降，且替罗非班组下降幅度明显大于常规治疗组；替罗非班组的sCD40L水平由（1．69±1．16）ng／ml降至（0．54±0．48）ng／ml，有显著性差异，而常规治疗组下降不显著。治疗前后两组hs—CRP水平比较均无显著性差异（P〉0．05）。随访30d，替罗非班组2例有顽固性心绞痛发作；对照组5例有顽固性心绞通发作，1例再发心肌梗死，两组无显著性差异。结论对于高危非ST段抬高急性冠脉综合征患者，盐酸替罗非班可有效抑制血小板聚集，显著降低sCD40L水平，使用盐酸替罗非班安全有效。

Effect of tirofiban in patients with non-ST-elevation acute coronary syndrome

Objective To observe the effect of tirofiban on platelet aggregation rate,serum sCD40L and hs - CRP level in patients with non - ST - elevation acute coronary syndrome and to follow up the cardiovascular events within 30 days. Methods 80 patients with high - risk non - ST - elevation acute coronary syndrome were enrolled. The patients were randomly divided into two groups. One group （n = 40） was treated with tirofiban, administered as a loading dose of 0.4μg/ （kg · min） over a 30 - minute period and followed by a 48 - hour infusion of 0. 1μg（ kg · min） , plus routine medicine. The other group （n = 40） was treated with routine medicine. ADP - induced platelet aggregation rate, serum sCD40L and hs - CRP level were measured before and after medication in two groups. Results The serum sCD40L level and platelet aggregation rate were decreased significantly in patients treated with tirofiban compared with the patients treated without tirofiban （ P 〈 0.01 ）. There was no significant difference between the two groups in serum hs - CRP level （P 〉 0.05）. There was no significant difference between the two groups in adverse events of bleeding and recurrence of cardiovascular events within 30 days. Conclusions Tirofiban can more rapidly,intensely and effectively inhibit platelet aggregation. It can significantly de- crease the level of sCD40L. In conclusion,tirofiban is effective and safe in patients with non - ST - elevation acute coronary syndrome.