替罗非班对急性冠脉综合征伴糖尿病患者介入术后心肌灌注及心肌损伤的影响

目的探讨替罗非班对急性冠脉综合征（ACS）伴糖尿病（DM）患者冠状动脉介入（PCI）术后心肌灌注及及心肌损伤的影响。方法选择ACs合并DM患者92例，随机分为两组，对照组（n=45）应用阿司匹林、氯吡格雷、低分子肝素钙抗凝等常规治疗；替罗非班组（n=47）在常规治疗基础上加用替罗非班。观察两组患者冠脉内注药20min后梗死相关动脉（IRA）的TIMI及心肌灌注血流分级，术后8h、12h、24h的心肌肌钙蛋白T（cTnT）、超敏C反应蛋白（hs—CRP），主要不良心血管事件及出血发生率。结果术后8h、12h、24h替罗非班组的cTnT、hs—CRP均显著低于对照组（P〈O．05或P〈0．01）。冠脉内注药后20min行冠脉造影，替罗非班组IRA的TIMI及心肌灌注血流分级均显著优于对照组（P〈0．05）。替罗非班组心血管事件发生率显著低于对照组（P〈0．05）；术后30d内两组出血并发症的发生率差异无统计学意义（P〉0．05）。结论在常规抗凝基础上合用盐酸替罗非班治疗ACS合并糖尿病患者，可明显改善心肌灌注，减少心肌损伤．减少心血管事件。

Influences of tirofiban on myocardial perfusion and myocardial injury in patients with acute coronary syndrome complicated diabetes mellitus after percutaneous coronary intervention

Objective To investigate the influences of tirofiban on myocardial perfusion and myocardial injury in the patients with acute coronary syndrome(ACS) complicated diabetes mellitus(DM) after percutaneous coronary intervention(PCI).Methods The patients with ACS complicated DM(n=92) were randomly divided into control group(n=45) treated with routine anticoagulation medicinals including aspirin,clopidogrel and low molecular weight heparin calcium,and tirofiban group(n=45),routine medicinals and tirofiban.The flow grads of TIMI of infarct-related artery(IRA) and myocardial perfusion 20 minutes after injection,and cardiac troponin T(cTnT),high sensitivity C-reactive protein(hs-CRP),and incidence of major adverse cardiovascular events(MACE) and bleeding complications were observed after 8 hours,12 hour and 24 hours.Results After 8 hours,12 hours and 24 hours,cTnT and hs-CRP were significantly lower in tirofiban group than those in control group(P<0.05 or P<0.01).After injection for 20 minutes,coronary angiography(CAG) was given to the patients.The flow grads of TIMI of IRA and myocardial perfusion were significantly better in tirofiban group than those in control group(P<0.05).The incidence of MACE was significantly lower in tirofiban group than that in control group(P<0.05).The difference in the incidence of bleeding complications was not statistically significant between two groups within 30 days after PCI.Conclusion On the basis of routine anticoagulation,hydrochloride tirofiban can significantly ameliorate myocardial perfusion,relieve myocardial injury and reduce MACE in the treatment of ACS complicated DM.