盐酸替罗非班治疗非ST段抬高急性冠脉综合征的临床疗效

目的观察盐酸替罗非班治疗非ST段抬高急性冠脉综合征（NSTE-ACS）的临床疗效及安全性。方法入选不稳定型心绞痛及非ST段抬高心肌梗死患者164例,随机分为观察组（n=82）和对照组（n=82）。对照组给予阿司匹林、低分子肝素、氯吡格雷等常规治疗;观察组在常规治疗基础上加用盐酸替罗非班[静脉负荷量0.4μg/（kg.min）,30 min后以0.1μg/（kg.min）维持,持续48～120 h]。观察两组患者治疗36 h及30d后的主要不良心血管事件（MACE）及不良反应的发生情况。结果观察组治疗36 h及30 d后的MACE发生率分别为：2.4%和6.1%对照组分别为：12.2%和18.5%,两组患者36 h及30 d MACE发生率差异均有统计学意义（P均〈0.05）。观察组与对照组出血发生率分别为：9.8%、6.1%,差异无统计学意义（P〉0.05）。两组均无严重的出血并发症及显著血小板减少。结论 NSTE-ACS患者在常规药物基础上联用盐酸替罗非班治疗可减少MACE的发生率,但增加轻微出血的发生率。     

替罗非班对急性冠脉综合征经皮冠状动脉介入术后无复流现象的影响

目的观察盐酸替罗非班对急性冠脉综合征（ACS）患者经皮冠状动脉介入术（PCI）后无复流现象的影响。方法纳入ACS患者行PCI治疗术后无复流患者72例,随机分为替罗非班组36例和对照组36例。对照组经冠状动脉给予硝普钠0.9μg/kg,替罗非班组经冠状动脉给予盐酸替罗非班负荷剂量10μg/kg,3min内注完,随后以0.15μg/（kg·min）微量泵持续静脉泵入24h。观察两组患者冠脉给药前、给药后20min靶血管前向血流的TIMI血流分级、心电图改变及术后2周内主要不良心脏事件及药物的不良反应。结果冠状动脉内给药20min后造影显示,两组患者梗死相关动脉TIMI血流分级均较给药前有改善,替罗非班组IRA的TIMI血流0级、1级发生率显著低于对照组,TIMI血流3级发生率显著高于对照组,差异均有统计学意义（P〈0.01）;冠状动脉给药2h后与给药前比较,对照组心电图改善不明显,而替罗非班组患者心电图获得显著改善,两组冠脉给药2h后ST抬高及压低程度、缺血损伤导联数差异均有显著统计学意义（P〈0.01）;术后2周内替罗非班组主要不良心脏事件显著低于对照组（P〈0.01）;术后2周内两组不良反应的发生率差异无统计学意义（P〉0.05）。结论经冠状动脉给予盐酸替罗非班治疗可有效地改善ACS患者术后无复流现象,并减少术后2周内主要不良心脏事件。     

国产替罗非班治疗急性冠脉综合征行PCI术患者的临床效果

目的评价国产血小板膜糖蛋白（GP）IIb/IIIa受体拮抗剂替罗非班（tirofiban）治疗急性冠状动脉综合征（ACS）患者在接受肝素（包括低分子肝素）、盐酸氯吡格雷、阿司匹林基础上实施经皮冠状动脉介入治疗术的有效性和安全性评价。方法将32例ACS患者按就诊顺序随机双盲分为受试组（加用替罗非班）和对照组（加用安慰剂）,所有患者均正规使用肝素（包括低分子肝素）、盐酸氯吡格雷、阿司匹林。疗程48 h,观察指标为心电图改变、出血并发症、血小板聚集率,终点事件是5 d内的复合缺血事件。结果受试组心电图ST段改善情况好于对照组[（0.50±0.08）mVvs（0.42±0.07）mV,P<0.01];出血并发症比对照组有增多趋势,但无统计学差异（14%vs9%）;血小板聚集率受试组明显下降（38%±8%vs44%±8%,P<0.05）,受试组用药前后比较（45%±7%vs38%±8%,P<0.01）,对照组用药前后比较（45%±8%vs44%±8%）;5 d复合终点事件发生率受试组低于对照组（0%vs18%,但差异无显著意义）。结论替罗非班在ACS常规治疗基础上可以进一步改善心电图缺血性改变,并能进一步加强抗血小板作用,且安全性良好。     

Effects of glycoprotein IIb/IIIa inhibition on clinical stabilization parameters in patients with unstable angina and non-Q-wave myocardial infarction

Glycoprotein IIb/IIIa receptor inhibition prevents the major cardiac events and improves the prognosis of patients with acute coronary syndromes. The purpose of the study was to evaluate the effects of tirofiban on clinical stabilization parameters in patients with unstable angina (UA) and non-Q-wave myocardial infarction (MI). Eighty-three patients presenting with prolonged ongoing chest pain and ST segment depression were included in the study. Forty-two patients were randomized to aspirin and heparin therapy, and 41 patients to tirofiban therapy in addition to the aspirin and heparin therapy. The interval between the initiation of the treatment and the disappearance of angina, recovery time of ST segment depression, creatine kinase-MB (CK-MB) levels, onset of decrease and normalization of CK-MB, and frequency of in-hospital major cardiac events were compared. The interval between initiation of the treatment and the disappearance of angina was significantly shorter in the tirofiban group (3.5 ± 4.2 vs 9.1 ± 8.6h, P 0.001). Recovery time of ST depression was also significantly shorter in the tirofiban group (5.1 ± 7.3 vs 12.3 ± 11.5h, P 0.05). The peak CK-MB values were significantly lower in the non-Q-wave MI and UA subgroups of tirofiban than in the heparin group (P = 0.04 for both). The onset of the CK-MB decrease was significantly earlier in the tirofiban group (15 ± 14 vs 24 ± 15h, P = 0.02). The normalization time of the CK-MB was relatively shorter in the tirofiban group but without statistical significance (50 ± 22 vs 60 ± 25h). The tirofiban group had a lower frequency of total major cardiac events (26% vs 54%, P = 0.01), acute MI (2.4% vs 19%, P = 0.03), and recurrent angina (26% vs 50%, P = 0.04). The frequency of death and urgent revascularization did not differ between the groups. Tirofiban, in addition to heparin, provides earlier clinical stability and prevents major in-hospital cardiac events in patients with UA and non-Q-wave MI as compared to heparin therapy alone.     

替罗非班对急性冠状动脉综合征患者临床症状和心电图的影响

目的 :评价血小板GPⅡb/Ⅲa受体拮抗剂替罗非班治疗急性冠状动脉综合征对于心绞痛症状和心电图的影响。方法 :将 78例急性冠状动脉综合征 (未包括ST段抬高的急性心肌梗死 )患者均分为受试组 (替罗非班加肝素 )和对照组 (替罗非班安慰剂加肝素 ) ,疗程 2 .0～ 4 .5d。观察用药期间心绞痛发作和心电图的变化情况。结果 :受试组心绞痛发作次数比对照组显著减少 (P <0 .0 5 ) ,心绞痛发作最长一次时间较对照组缩短 30 .5 %。受试组心电图ST段较对照组也有较多改善趋势。结论 :替罗非班在急性冠状动脉综合征常规治疗基础上可以进一步缓解心绞痛症状和改善心电图。     

不同剂量氯吡格雷与替罗非班联用治疗急性心肌梗死临床研究

目的探讨不同剂量氯吡格雷与替罗非班联用治疗急性心肌梗死的临床效果,为临床治疗剂量选择提供依据。方法选取博兴县第二人民医院心内科2010年5月至2012年1月收治急性心肌梗死患者180例,采用随机数字表法分为小剂量组和大剂量组,各90例。其中小剂量组患者采用氯吡格雷350 mg+替罗非班联合治疗;大剂量组患者采用氯吡格雷600 mg+替罗非班联合治疗。比较两组患者治疗前后血浆可溶性CD40配体(s CD40L)、血小板源性生长因子-BB(PDGF-BB)指标,ST段下降幅度,缺血导联个数及心脏不良事件发生情况。结果治疗前,小剂量组和大剂量组患者血浆s CD40L、PDGF-BB水平,ST段下降幅度及缺血导联个数比较差异无统计学意义(P>0.05);治疗后,两组患者血浆s CD40L、PDGF-BB水平,ST段下降幅度及缺血导联个数较治疗前均显著降低,且大剂量组患者治疗后上述各指标均显著低于小剂量组[(150.3±26.9)μg/L vs(194.5±33.4)μg/L,(2071.7±577.8)μg/L vs(2564.2±623.6)μg/L,(0.33±0.09)mm vs(0.65±0.14)mm,(1.74±0.48)个vs(2.86±0.87)个],差异均有统计学意义(P<0.05);同时大剂量组患者心绞痛再发、心肌梗死再发及病死率均低于小剂量组(8.9%vs 23.3%,1.1%vs11.1%,1.1%vs 8.8%),组间比较差异有统计学意义(P<0.05)。结论大剂量氯吡格雷与替罗非班联用治疗急性心肌梗死相较于常规剂量可有效改善心肌缺血,减少心脏不良事件发生风险。     

急性心肌梗死PCI术前早期应用国产替罗非班对预后的影响

目的 探讨血小板GPⅡb/Ⅲa受体拮抗剂国产替罗非班在急性STEMI患者急诊PCI术前应用的临床疗效.方法 对急救中心收入本科并确诊急性STEMI的120例患者随机分为治疗组和对照组,各60例.两组均接受急诊PCI术,治疗组于入院时即应用替罗非班,对照组未用.主要观察：①PCI手术前后梗死相关动脉TIMI血流;②术后相关导联抬高的ST段回落幅度;③术后4周行超声心动图检查测定左心室射血分数（LVEF）值;④住院期间出血并发症及继发的血小板减少症的发生率;⑤术后3个月的心血管主要不良事件（MACE）发生情况.结果 两组患者临床基本资料无明显差异.替罗非班组术前梗死相关动脉TIMI 0～1级与对照组比较差异有统计学意义（70.0％比90.0％,P＜0.05）,两组PCI术前TIMI 3级比较差异无统计学意义（13.3％比0,P＞0.05）,两组PCI术后TIMI 3级比较有差异有统计学意义（86.7％比63.3％,P＜0.05）.替罗非班组术后2h心电图相关导联ST段完全回落幅度（STR≥70％）高于对照组（P＜0.05）.术后4周超声心动图提示对照组LVEF低于替罗非班组（P＜0.05）.术后替罗非班组轻度出血事件较对照组略有增多,但两组差异无统计学意义（P＞0.05）.两组近期MACE发生率差异无统计学意义（P＞0.05）.结论 急性STEMI患者急诊行PCI术前早期应用国产替罗非班能改善术后心肌再灌注,挽救濒死心肌,恢复存活心肌细胞功能,改善心功能;未明显增加出血事件及主要心血管不良事件,是安全有效的.     

Prolonged systemic delivery of tirofiban in a thrombus-laden saphenous vein graft

Results from previous trials have shown conflicting results from local delivery of thrombolytic agents to diminish thrombus burden before intervention in native coronary arteries and saphenous vein grafts. We described a patient with an acute coronary syndrome who was treated for 24 hours with systemic tirofiban (Aggrastat®), a glycoprotein IIb/IIIa inhibitor, for the treatment of a degenerated saphenous vein graft with a TIMI grade 4 thrombus (large-sized thrombus). Angiographic evaluation 48 hours later revealed complete resolution of the thrombus with normal coronary blood flow. (Int J Cardiovasc Intervent 2003; 5: 92-94)     

半量替罗非班治疗高龄急性冠脉综合征患者的血栓弹力图评价

目的：用血栓弹力图评价半量替罗非班治疗高龄急性冠脉综合征（ACS）患者的效果。方法：行急诊经皮冠状动脉介入术的高龄ACS患者126例被随机分为替罗非班半量组和全量组,各63例。两组均常规应用阿司匹林、氯吡格雷,手术前开始应用替罗非班。监测两组术前、术后12h的血栓弹力图变化。观察两组住院期间的不良反应（出血、血小板减少）及30d内的主要心血管事件（死亡、再梗死、靶血管重建、亚急性支架内血栓形成）。结果：与术前比较,两组术后12ha角[半量组：（61．3±14．7）。比（38．5±8．2）°,全量组：（58．7±12．8）°比（36．1±5．7）°]、曲线最大幅度（MA值）[半量组：（49．3±17．8）mm比（24．8±12．5）mm,全量组：（54．2±19．6）mm比（21．4±13．6）mm]均显著下降（P均〈0．01）;二磷酸腺苷（ADP）诱导的血小板抑制率[半量组：（27．5±14．3）％比（69．3±18．2）％,全量组：（32．4±15．2）％比（72．6±20．3）％]显著增加（P〈0．01）。术前及术后12h两组间各血栓弹力图参数比较无显著差异（P〉0．05）。住院期间两组出血事件发生率（11．1％比17．5％）和血小板减少发生率（9．5％比11．1％）,全量组轻度增多,但无显著差异（P〉0．05）。随访期间两组主要心血管事件发生率无显著差异（15．9％比14．30．4,P〉0．05）。结论：行急诊经皮冠状动脉介入术治疗的高龄急性冠脉综合征患者,半量替罗非班相对安全、有效,值得临床推荐。     

替罗非班对急性心肌梗死患者介入术后心肌灌注和血小板活化功能的影响

目的 探讨替罗非班对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后心肌灌注和血小板活化功能的影响.方法 80例AMI患者按随机数字表法分为2组,均于发病12 h内行急诊PCI术.对照组40例采用常规抗凝治疗(阿司匹林+低分子肝素+氯吡格雷).替罗非班组40例在对照组治疗的基础上于PCI术中冠状动脉内注入盐酸替罗非班10μg/kg,静脉维持量0.15 μg/(kg·min)36 h.观察2组PCI术后15 min梗死相关血管心肌灌注分级(TMPG)、治疗前及治疗7 d后血小板活化功能的变化、术后30 d内出血并发症及主要不良心脏事件(MACE)的发生情况.结果 替罗非班组PCI术后15 min TMPG灌注3级的百分比显著高于对照组[97.5%(39/40)与80.0%(32/40),x2=4.507,P＜0.05];治疗7 d后,替罗非班组的血小板活化指标血小板α颗粒表面膜糖蛋白、溶酶体膜糖蛋白、单核细胞血小板聚集体的阳性表达率显著低于治疗前和对照组[替罗非班组治疗后:(1.7±0.7)%、(1.5±0.7)%、(11.7±3.8)%,治疗前:(7.2±2.5)%、(6.9±1.8)%、(22.0±7.8)%,t值分别为13.398、17.683、7.508;对照组治疗后:(2.9±1.2)%、(3.9±0.6)%、(16.2±4.2)%,t值分别为5.463、16.468、5.025,P均＜0.01];治疗30 d后,替罗非班组心血管事件发生率显著低于对照组(0%与15.0%(12/40),x2=4.504,P＜0.05);2组出血并发症发生率比较差异无统计学意义(10.0%(4/40)与5.0%(2/40),x2=0.180,P＞0.05).结论 在AMI介入治疗中,应用盐酸替罗非班能改善心肌灌注,进一步抑制血小板的活化功能,减少PCI术后主要不良心脏事件的发生率,且不增加严重出血的发生.

Abstract：

Objective To evaluate the influence of tirofiban on myocardial perfusion through percutaneous coronary intervention (PCI) and platelet activation in patients with acute myocardial infarction (AMI). Methods Eighty patients with acute myocardial infarction who underwent emergency PCI within 12 hours were randomly divided into 2 groups due to the random number table method: tirofiban group (40 patients) and control group (40 patients). The control group received conventional anticoagulant therapy (aspirin + low molecular weight heparin + clopidogrel). The tirofiban group additionally received intracoronary tirofiban hydrochloride injection of 10 μg/kg PCI during PCI, intravenous maintenance dose of 0. 15 after PCI 15 mins, the changes of platelet activation before and after treatment 7 days,the bleeding complications and major adverse cardiac events (MACE) within 30 days after PCI. Results The TMPG 3 perfusion percentage of tirofiban group (97.5% ,39/40) after PCI 15 minutes was significantly higher than that (80. 0%,32/40) of the control group( x2 = 4. 507,P ＜ 0. 05 ) ;The expression positive rate of platelet activation CD62P,CD63, MPA of the tirofiban group after treatment of 7 days were ( 1.7 ± 0. 7 ) %, ( 1.5 ± 0. 7 ) % and ( 11.7 ±3.8)% ,respectively,which were significantly lower than those of before treatment ([7.2 ± 2. 5]%, [6. 9 ±1.8]% and [22. 0 ± 7. 8] %, respectivley) and those of the control group after treatment of 7 days ( [2. 9 ±1.2]% ,[3.9 ±0.6]% and [16.2 ±4.2]% ,respectivley)(t =5.463,16. 468 and 5.025, Ps ＜0.01 );The incidence of cardiovascular events of the tirofiban group (0) was significantly lower than that of the control group ( 15.0%, 12/40 ) after treatment of 30 days ( x2 = 4. 504, P ＜ 0. 05 ); The incidence of bleeding complications was not significant between the 2 groups ( x2 = 0. 180, P ＞ 0. 05 ). Conclusion The application of tirofiban hydrochloride in intervention in acute myocardial infarction can improve myocardial perfusion, and further inhibiting platelet activation and reduce the incidence of major adverse cardiac events after PCI while does not increase the incidence of severe bleeding.