氯吡格雷治疗非ST段抬高急性冠状动脉综合征临床观察

目的：比较氯吡格雷和噻氯匹定治疗非ST抬高(NSTE)急性冠状动脉综合征(ACS)患者的两组患者抗血小板聚集作用的效果、心脏事件发生率及药物副作用。方法：NSTE急性冠状动脉综合征183例，分为不稳定型心绞痛(UAP)129例和非ST抬高心肌梗死(NSTEMI)54例，分入治疗组94例和对照组89例，治疗组在给予阿司匹林标准剂量抗血小板治疗的同时给予氯吡格雷治疗，对照组则用阿司匹林加噻氯匹定进行抗血小板治疗，检测治疗前和治疗8周两组患者血小板聚集率、血栓和止血功能，统计两组治疗后心脏事件的发生率，总结两物的副作用。结果：治疗8周后的血小板聚集率与治疗前相比，差异具有显著性，而止血和血栓功能相似；治疗后两组心脏事件的发生率相似；噻氯匹定与氯吡格雷的副作用中性粒细胞减少(3．4％比0)、胃肠道反应(11．2％比6．3％)、皮疹(9．0％比3．2％)，两组差异具有显著性。两组均无需要停药病。结论：氯吡格雷治疗NSTE急性冠状动脉综合征与噻氯匹定同等有效，而副作用的发生率较噻氯匹定减少，其主要是胃肠道反应和皮疹，但不影响治疗。

Clinical Study on the Treatment of Non-ST-elevation Acute Coronary Syndrome with Clopidogrel

Objective: To compare the effect against platelet aggregation, incidence of cardiac event and side effect of treatment of non-ST-elevation acute coronary syndrome with Clopidogrel and Ticlopidine. Method: One hundred and eighty three patients with non-ST-elevation (NSTE) acute coronary syndrome, including 129 cases of unstable angina pectoris (UAP) and 54 cases of non-ST-elevation myocardial infarction (NSTEMI), were divided into two groups: treatment group (94) and control group (89). The treatment group was administrated standard dose of aspirin and Clopidogrel. The control group received aspirin and Ticlopidine treatment. Levels of platelet aggregation rate and hemostatic function of pretreatment and 8 weeks after treatment were observed. The incidence of cardiac event and side effect of two groups after treatment were compared. Result: Platelet aggregation rate of pretreatment and 8 weeks after treatment had significant difference, but hemostatic functions were similar. The incidence of cardiac event of two groups had no significant difference. The side effect of Clopidogrel and Ticlopidine had significant difference with granulocytopenia (3.4% vs. 0), gastrointestinal tract response (11.2% vs. 6.3%) and exanthem (9.0% vs. 3.2%) respectively, which need no drug withdrawal. Conclusion: Clopidogrel has the same effect on NSTE acute coronary syndrome with fewer side effects than Ticlopidine. The side effect included gastrointestinal tract response and exanthem, which had no influence no treatment.