非ST段抬高急性冠脉综合征早期介入治疗前应用替罗非班的临床研究

目的：探讨盐酸替罗非班对非ST段抬高急性冠脉综合征（NSTE-ACS）患者早期介入治疗的疗效和安全性。方法：选择NSTE-ACS的中高危患者95例，随机分为替罗非班试验组（n=48）和对照组（72=47），均于入选后72h内接受早期PCI治疗。比较两组间基础临床资料、PCI前后病变血管血流TIMI分级、术后12h血清肌钙蛋白（cTnT）和肌酸激酶同工酶（CK—MB）水平、出血事件和血小板减少以及30d主要心血管事件（MACE）的发生率。结果：试验组和对照组最终分别入选了47例和44例患者。两组间基础临床资料无统计学差异，试验组应用替罗非班后PCI术前病变血管前向血流达到TIMI3级的比率高于对照组（61．7％VS47．7N，P〈O．05），术后TIMI3级血流获得率试验组较对照组高（95．7％VS88．6％），但未达到统计学差异；术后试验组cTNT和CK－MB升高发生率较对照组明显减低（10．6％VS20．5％，P〈0．05）。两组出血事件和血小板减少以及30dMACE发生率差异无统计学意义（P〉0．05）。结论：NSTE-ACS患者早期介入治疗术前应用盐酸替罗非班是安全有效的，能够提高PCI术前病变血管前向血流，并减少PCI术后的心肌损伤。

Clinical Study of Pre-angiographic Use of Tirofiban in Early PCI for Patients With non-ST Elevation Acute Coronary Syndrome

Objective： To explore the efficacy and safety of tirofiban used in early PCI for patients with non-ST elevation acute coronary syndrome （NSTE-ACS）. Methods： Ninety-five middle-high risk patients with NSTE-ACS were randomly divided into two groups： the tirofiban group （n = 48） and the control group （n = 47）. All patients received early PCI within 72 hours. Basic clinical characteristics, TIMI flow before and after PCI, serum level of cTnT and CK-MB after PCI, incidences of bleeding and thrombocytopenia in the hospital, and the incidences of major adverse cardiac events （MACE） at 30th day were compared between two groups. Results： Totally 91 NSTE-ACS patients were accomplished this study （tirofiban group, 47cases, control group： 44 cases）. There were no significant differences in basic clinical characteristics between the two groups. The percentage of TIMI 3 flow achieved in tirofiban group before PCI was higher than that in control group （61.7% vs 47. 7%, P〈0. 05）, but there were no significant difference in percentage of TIMI 3 flow achieved after PCI between the two groups. The incidence of increased cTnT and CK MB in tirofiban group was significantly lower than that in control group （10. 6% vs 20. 5%, P〈0. 05） after intervention. There were no significant differences in occurrence of bleeding complication and MACE in both groups （P〉0. 05）. Conclusions.. It is safe and effective for pre-angiographic use of tirofiban in early PCI for patients with non-ST elevation acute coronary syndrome. Tirofiban can increase blood flow before PCI, improve myocardial perfusion, and reduce myocardial injury after PCI.