替罗非班在老年人急性心肌梗死介入治疗中的干预研究

目的 探讨血小板膜糖蛋白(GP)Ⅱb/Ⅲ a受体拮抗剂替罗非班对老年急性心肌梗死患者急诊行冠状动脉介入治疗的疗效及安全性方法选择2007年5月至2009年11月入院并明确诊断为急性ST段抬高心肌梗死老年患者120例,行急诊经皮冠状动脉介入治疗术(PCI),随机分为对照组、替罗非班常规剂量组和小剂量替罗非班组;观察各组患者冠状动脉复流及并发出血情况.用酶联免疫吸附法测定凝血因子组织因子(TF)、血管性假血友病因子(vWF)]、细胞黏附分子(sICAM-1和sVCAM-1) 结果3组最终人选患者分别为38例、39例和39例;3组间基础临床资料差异无统计学意义;PCI术后替罗非班组达到TIMl3级血流者(常规剂量组和小剂量组分别为32例和30例)较对照组(22例)高(P<0.05);替罗非班组出血事件发生率(12.8%和5.1%)高于对照组(2.6%)(P<0.05),但在常规剂量及小剂量组间差异无统计学意义(P>0.05);与对照组TF为(387±95)ng/L,vWF为(290士45)μg/L,sICAM-I为(35.6±2.1)μg/L,sVCAM-I为(34.1±2.4)μg/L]相比,替罗非班组凝血因子常规剂量组和小剂量组TF分别为(208±73)ng/L和(232±79)ng/L.vWF分别为(182±58)μg/L和(195±39)μg/L3,细胞黏附分子(常规剂量组和小剂量组术后72 hsICAM-I分别为(22.9±2.0)μg/L和(23.5±2.2)/μg/L,sVCAM-I分别为(23.2±2.1)/μg/L和(24.9 ±2.6)μg/L]较低(P<0.05) 结论替罗非班在老年人急性心肌梗死介入治疗中是安全有效的,小剂量相对于常规剂量能达到同样的临床效果并可能减少出血并发症的发生.

Investigation of the efficacy and safety of tirofiban in elderly patients with acute myocardial infarction referred for percutaneous coronary intervention

Objective To evaluate the efficacy and safety of use of platelet membrane glycoprotein (GP) Ⅱ b/Ⅲ a inhibitor tirofiban for percutaneous coronary interventional (PCI) in elderly patients with acute ST segment elevation myocardial infarction (STEMI).Methods A total of 120 elderly patients who suffered from STEMI and underwent PCI were selected from July 2007 to November 2009.The patients were randomly assigned to control group, standard-dose tirofiban group and low-dose tirofiban group.We observed coronary blood reflow, the bleeding complication, coagulation factor(TF,vWF) and cell adhesion molecular(sICAM-1 and sVCAM-1).Results Total 116 patients accomplished this study (control group: 38 cases; standard-dose group: 39 cases; low-dose: 39 cases).The percentages of TIMI 3 flow after PCI were higher in the two tirofiban groups than in control group (P<0.05).The incidences of bleeding complications in both tirofiban groups (12.8%,5.1%) were higher than that in control group (2.6%, P<0.05).The concentration of TF, vWF,sICAM-1 and sVCAM-1 were lower in both tirofiban groups than in control group(P< 0.05).Conclusions GP Ⅱ b/Ⅲ a inhibitor tirofiban can benefit the elderly patients with STEMI referred for PCI therapy, low-dose tirofiban may offer almost the same level of efficacy as standard-dose, with less associated bleeding.