半剂量替罗非班联合PCI对早期肾功能不全急性心肌梗死患者的疗效及安全性

目的：观察半剂量替罗非班联合经皮冠脉介入治疗（PCI）对合并早期肾功能不全急性心肌梗死（AMI）患者的疗效及安全性。方法：选择合并早期肾功能不全的AMI患者55例作为肾功能不全组，56例肾功能正常的AMI患者作为AMI对照组，两组均应用常规抗凝、抗血小板治疗，肾功能不全组于穿刺成功后开始应用半剂量替罗非班，AMI对照组全量应用替罗非班。比较两组间住院期主要不良心血管事件（MACE），出血、血小板减少发生率及对比剂肾病发生率的差异。结果：与AMI对照组比较，肾功能不全组3支病变比例（21．1％比43．60）、术后肌酸激酶峰值浓度[（1863．1±86．7）IU／L比（2371．5±126．3）IU／L]明显升高（P均〈0．05）；两组术后TIMI3级血流率、校正的TIMI计帧数和Blush3级率未见显著性差异（P〉0．05），术后2h心电图相关导联ST段下降幅度及住院期间的MACE发生率亦无显著性差异（P〉0．05），出血事件发生率和血小板减少发生率亦无显著差异（P〉0．05）。对比剂肾病：AMI对照组无发生，肾功能不全组有3例发生（0％比5．45％，P〈0．05）。结论：合并早期。肾功能不全的急性心肌梗死患者三支病变比例高，半剂量替罗非班联合PCI能有效再灌注心肌，降低住院心血管事件发生，未见明显出血及血小板减少发生率增加，但需警惕对比剂肾病的发生，术后应加强监测与干预。

Therapeutic effect and safety of half dose tirofiban combined PCI in patients with acute myocardial infarction complicated early renal insufficiency

Objective:To investigate therapeutic effect and safety of half dose tirofiban combined percutaneous coronary intervention(PCI) on patients with acute myocardial infarction(AMI) complicated early renal insufficiency.Methods:A total of 55 AMI patients with early renal insufficiency were enrolled as renal insufficiency group and 56 AMI patients with normal renal function were regard as AMI control group.Both groups received routine anticoagulant and antiplatelet therapy,renal insufficiency group received half dose tirofiban after successful puncture while AMI control group was given full dose tirofiban.Incidence rates of major adverse cardiovascular events(MACE),bleeding,thrombocytopenia and contrast induced nephropathy(CIN) were observed and compared between two groups.Results:Compared with AMI control group,there were significant increase in ratio of triple-vessel disease(21.1% vs.43.6%) and peak concentration of creatine kinase after PCI [(1863.1±86.7) IU/L vs.(2371.5±126.3) IU/L] in renal insufficiency group(P<0.05 both);there were no significant difference in TIMI flow grade 3,corrected TIMI frame count and Blush grade 3,in descent extent of ST segment on relative leads of echocardiogram on 2h after PCI and incidence rate of MACE during admission after PCI between two groups(P>0.05).There were no significant difference in incidence rates of bleeding and thrombocytopenia between two groups(P>0.05).No case occurred CIN in AMI control group,there were three CIN cases in renal insufficiency group(0% vs.5.45%,P<0.05).Conclusion:Ratio of triple-vessel coronary disease is high in AMI patients with early renal insufficiency.Half dose tirofiban combined PCI can effectively accomplish myocardial reperfusion,decrease incidence of MACE during admission,and there are no significant increase in incidence rates of bleeding and thrombocytopenia.However,incidence of CIN should be paid attention,and monitor and intervention should be emphasized after PCI.