老年冠心病患者氯吡格雷联用钙拮抗剂的疗效观察

目的：观察老年冠心病患者使用氯吡格雷（氯吡格雷）联用钙拮抗剂（CCB）的疗效。方法选取我院2010年1月～2013年5月收治的1142名有完整住院治疗资料和随访记录的老年冠心病患者进行回顾性分析，其中仅服用氯吡格雷进行治疗的患者有512例（A组），服用氯吡格雷联用钙拮抗剂的患者有630例（B组），B组患者中，有562例患者服用的是二氢吡啶类CCB，另外68例患者服用的是非二氢吡啶类CCB,通过对比观察其治疗效果。结果A组的发病密度为40.28/1000，B组患者的发病密度42.14/1000，粗RR为0.7995% CI：（0.49-1.15）]，调整后的RR为0.5195% CI：（0.17-1.43）]，两组的全因死亡率（P＞0.05），差异无统计学意义，两组的终点事件发生率（P＞0.05），差异无统计学意义。对两组患者进行混杂因素的倾向评分加权对比，服用二氢吡啶类CCB和服用非二氢吡啶类CCB的患者对比，OR=1.8395% CI：（1.3-3.25）]，差异有统计学意义（P＜0.05）。结论老年冠心病患者服用氯吡格雷联用钙拮抗剂进行治疗，不会使缺血性心脑血管事件以及全因死亡率增加，服用氯吡格雷联用二氢吡啶类CCB发生缺血性脑血管事件的机率，比服用氯吡格雷联用非二氢吡啶类CCB要低。

Efficacy of clopidogrel associated with calcium antagonists in the treatment of elderly patients with coronary heart disease

Objective To observe clinical efficacy of clopidogrel associated with calcium antagonists in the treatment of elderly patients with coronary heart disease. Methods 1142 elderly patients with coronary heart disease who had complete hospitalization data and follow-up records in our hospital from January 2010 to May 2013 were selected,of these patients,there were 512 cases were only taken Clopidogrel（A group）,there were 630 cases taken clopidogrel and calcium antagonists（B group）,in the B group, there were 562 cases taken dihydropyridine CCB,other 68 cases were taken non-dihydropyridine CCB,observed their efficacy. Results Incidence density of the A group was 40.28/1000,Incidence density of the B group was 42.14/1000,Crude RR was 0.7995% CI：（0.49-1.15）],Adjusted RR was 0.5195% CI：（0.17-1.43）],All-cause mortality of the two groups, P ＆gt; 0.05,there had no statistically significant;endpoint events incidence of the two groups,P ＆gt; 0.05,there had no statistically significant;confounders of the two groups were given propensity score weighting contrast,the patients who took dihydropyridine CCB were compared with the patients with non-dihydropyridine CCB, OR=1.8395% CI：（1.3-3.25）],There were significant differences, it had statistical significance（P〈0.05）. Conclusion It can not increase ischemic cardiovascular events and all-cause mortality of elderly patients with coronary heart disease using clopidogrel and calcium antagonists;the ischemic cerebrovascular event probability is lower of clopidogrel with dihydropyridine CCB than clopidogrel with non-dihydropyridine CCB.