替罗非班并依诺肝素对糖尿病伴非ST段抬高急性冠脉综合征的疗效.doc

替罗非班并依诺肝素对糖尿病伴非ST段抬高急性冠脉综合征的疗效 　　作者：白宏兴，拓胜军，王丽娟，李　毅 作者单位：陕西省延安市人民医院心血管内科，陕西 延安　716000 　　【摘要】 目的：探讨替罗非班与依诺肝素联合应用对糖尿病合并非ST段抬高急性冠脉综合征(NSTEACS)的有效性和安全性。方法：选择我院2009年3月～2011年3月确诊为糖尿病合并NSTEACS患者90例，随机分为常规治疗组(44例，主要采用阿司匹林、依诺肝素等治疗);替罗非班组(46例，在常规治疗基础上加用国产替罗非班)。观察48h、30d时主要不良心血管事件(MACE)的发生率，活化部分凝血激酶时间(APTT)、血小板计数变化，以及有无出血等并发症。结果：替罗非班组48h、30d的MACE发生率明显低于常规治疗组(48h：4.3%比20.5%,30d：13.0%比29.5%，P0.05);两组治疗前，治疗后48h、7d时APTT、血小板计数无显著差异(P0.05)，两组出血并发症无显著差异(P0.05)。结论：替罗非班与依诺肝素联合治疗糖尿病合并非ST段抬高急性冠脉综合征患者是有效和安全的。 　　【关键词】 糖尿病,冠状动脉疾病,依诺肝素,替罗非班 　　Abstract：Objective：To investigate efficacy and safety of tirofiban combined with enoxaparin in patients with diabetes mellitus (DM) complicated non-ST segment elevation acute coronary syndrome (NSTEACS). Methods：A total of 90 patients diagnosed as DM complicated NSTEACS from Mar 2009 to Mar 2011 in our hospital were randomly divided into routine treatment group (44 cases，received treatment with aspirin，enoxaparin etc.) and tirofiban group (46 cases，received domestic tirofiban based on routine treatment). Incidence rates of major adverse cardiovascular events (MACE) on 48h and 30d，changes of activated partial thromboplastin time (APTT) and platelet counting and complication of hemorrhage were observed in the two groups. Results：Compared with routine treatment group，there were significant decrease in incidence rates of MACE on 48h and 30d (48h：20.5% vs. 4.3%,30d：29.5% vs. 13.0%，P0.05) in tirofiban group;there were no significant difference in APTT and platelet counting before,48h and 7d after treatment between the two groups (P0.05)，and no significant difference existed in complication of hemorrhage between the two groups (P0.05). Conclusion：Application of tirofiban combined with enoxaparin is effective and safe in patients with diabetes mellitus complicated non-ST segment elevation acute coronary syndrome. 　　Key words：Diabetes mellitus;Coronary artery disease;Enoxaparin;Tirofiban 　　糖尿病合并非ST段抬高急性冠脉综合征(NSTEACS)包括非ST段抬高性心肌梗死(NSTEMI)和不稳定