替罗非班治疗非ST段抬高急性冠脉综合征的安全性和疗效评价

目的观察血小板膜糖蛋白Ⅱb／Ⅲa受体拮抗剂盐酸替罗非班治疗非sT段抬高急性冠脉综合征（NSTE—ACS）的安全性和疗效。方法选择我院心内科住院治疗的204例NSTE—ACS患者，随机分为试验组（替罗非班＋常规治疗组103例）和对照组（常规治疗组101例）。在常规使用阿司匹林、氯吡格雷和低分子肝素的基础上，试验组给予替罗非班10μg／kg在3min内弹丸式注射，随后以0．1μg·kg-1·min。由微量泵持续泵人24h，比较两组的治疗效果。结果试验组24h及30d的主要不良心脏事件（MAcE，包括顽固性心绞痛、新发心肌梗死、死亡）发生率明显低于对照组（24h：2．9％比16．8％；30d：5．8％比25．7％，P〈0．01）。试验组肌钙蛋白T（cTnT）峰值水平及24h平均水平均明显低于对照组（1．45±0．56）ng／L比（2．51±0．52）ng／L，（1．20±0．53）ng／L比（1．83±0．43）ng／L]（P均〈0．01）；72h心电图ST段恢复比例试验组和对照组分别为68．4％和31．6％，试验组明显高于对照组，差异有统计学意义（P〈0．05）。两组的主要不良反应为出血，发生率分别为12．1％和7．2％，两组之间的出血并发症发生率差异无统计学意义（P〉0．05）。结论替罗非班作为一种高效、高选择性的血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂，在NSTE—ACS的标准治疗基础上能进一步减少心肌缺血事件，减少心肌细胞的损伤，与肝素和阿司匹林联合使用治疗NSTE—ACS是安全有效的。

Efficacy and safety of tirofiban hydrochloride in patients with non ST-segment elevation acute coronary syndrome

Objective To investigate the efficacy and safety of the specific glycoprotein Ⅱb/Ⅲa inhibitor （tirofiban） in non ST-segment elevation acute coronary syndrome（NSTE-ACS） patients. Methods 204 patients of Non ST-segment elevation acute coronary syndrome admitted in the Second People＇s Hospital in Guiyang City were randomly divided into trial group （tirofiban± conventional treatment, n= 103 ） and control group （conventional treat- ment, n= 101 ）. The conventional treatment included aspirin, clopidogrel and low molecular heparin. Tirofiban were given in trial group, 10 μg/kg for bolus in 3 min, followed by 0.1 μg·kg-1·min-1 infusion,maintained for a mean of 24 h. The therapeutic effects in two groups were compared. Results The incidence of the major primary end point （MACE, including refractory ischemia, new myocardial infarction and death） in trial group at 24 hours and 30 day was obviously lower than that in the control group （24 h：2.9% vs 16.8%, 30 d：5.8% vs 25.7%, P〈0.01）. The peak level of cTnT and 24 h average level in trial group were significantly lower than the control group （ 1.45±0.56）ng/Lvs （2.51±0.52）ng/L, （ 1.20±0.53 ）ng/L vs （ 1.83±0.43）ng/L] （P〈0.01）. There were also im- provements at 72 h in ST segment depression and the number of ischemic leads in the tirofiban group than those in the control group （68.4% vs 31.6%, P〈0.05）. The major adverse reaction as bleeding incidence was 12.1% and 7,2% respectively, The bleeding complication in two groups has no statistically significant （P〉0.05）. Conclusion Tirofiban is a highly efficient and selectivity glyeoprotein Ⅱb/Ⅲa inhibitor, It can further reduce myocardial is- chemic events on standard treatment of NSTE-ACS, and reduce the myocardial injury. Combination treatment of Tirofiban, heparin and aspirin is safe and effective in patients with NSTE-ACS.