老年冠状动脉粥样硬化性心脏病患者氯吡格雷联用钙拮抗剂的疗效分析

目的研究对老年冠状动脉粥样硬化性心脏病（简称冠心病）患者使用氯吡格雷加钙拮抗剂（CCB）治疗的临床效果。方法对l021例老年冠心病患者，均服用氯吡格雷进行治疗，其中402例患者仅运用氯吡格雷进行治疗，其余619例患者加服钙拮抗剂，619例中有547例患者服用二氢吡啶类钙拮抗剂，72例患者服用非二氢吡啶类钙拮抗剂，观察临床疗效。结果氯吡格雷组与联用CCB组患者发病密度（全因死亡）分别为55．55／1000，42．02／1000，相对危险（RR）为0．83[95％c，：（0．55—1．26）]，调整后的RR为0．47[95％cI：（O．14—1．6）]，两组患者的全因死亡率，未见明显差异（P〉0．05）；两组患者终点事件的发生率未见明显差异（P〉0．05）。对所选的患者混杂因素进行倾向评分加权后，服用非二氢吡啶类CCB比二氢吡啶类CCB发生缺血性脑血管事件的风险高，标准化死亡率加权法（SMRW）调整OR=1．97[95％：（1．2—3．23）]，P=0．007。结论老年冠心病患者运用氯吡格雷加钙拮抗剂治疗不会使缺血性心脑血管事件及全因死亡的发生率增加，多种代谢途径CCB之间死亡率未见明显差异，服用非二氢吡啶类CCB比二氢吡啶类CCB发生缺血性脑血管事件的风险高。

Observation on Curative Effect of Clopidogrel Combined with Calcium Antagonists in Elder- ly Patients with Coronary Atherosclerosis Heart Disease

Objective To study the clinical effect of clopidogrel plus calcium antagonist （CCB） in the treatment of elderly coronary atherosclerosis heart disease（CAHD）. Methods 1 021 cases of elderly CAHD took clopidogrel treatment, including 402 cases treated with only clopidogrel and the remaining 619 cases added with oral calcium antagonists. The curative effects were observed. Results The incidence density （all-cause mortality） in the clopidogrel group and the combined CCB group were 55.55/1 000 and 42.02/1 000 respectively, the relative risk（RR） was 0.83 （95% CI：O. 55 - 1.26）, the adjusted RR was 0. 47 （95% CI：O. 14 - 1.6）, the all - cause mortality had no significant difference between the two groups（P 〉 0.05）;the end event incidence rate had no significant difference between the two groups（ P 〉 0.05）. After the confounders propensity score weighting in the selected patients,taking non-dihydropyri- dine CCB had the higher risk of ischemic cerebral vascular event than taking dihydropyridine CCB,SMRW adjusting OR = 1.97 （95%： I. 2- 3.23）, P = 0.007. Conclusion Elderly patients with CAHD taking clopidogrel plus calcium antagonists does not increase the in- cidence rate of ischemic cardiocerebrovascular events and the all- cause mortality, the mortality rates had no significant difference a- mong various metabolic routes CCB,taking non- dihydropyridine CCB has the higher risk of ischemic cerebrovascular events occurrence than taking dihydropyridine CCB.