氯呲格雷聯合尿激酶治療AMI的效果及對其凝血功能、炎癥水平的影響

林康華　黃飛龍

【摘要】 目的：研究氯呲格雷聯合尿激酶治療急性心肌梗死（AMI）的效果及對其炎癥水平的影響。方法：選取2018年5月-2019年8月于筆者所在醫院就診的AMI患者83例，按照隨機數字表法分為對照組（41例）和研究組（42例）。對照組行尿激酶聯合阿司匹林治療，研究組行尿激酶聯合氯吡格雷治療。觀察兩組臨床療效、凝血功能、炎癥水平、不良反應發生率。結果：研究組臨床治療總有效率（90.48%）高于對照組（80.49%），差異有統計學意義（P<0.05）。治療后研究組血小板聚集率（PAG）低于對照組，活化部分凝血活酶時間（APTT）、凝血酶原時間（PT）均長于對照組，差異均有統計學意義（P<0.05）;治療后研究組C反應蛋白（CRP）、肌酸激酶同工酶MB亞型（CK-MB）、肌鈣蛋白T（TnT）均低于對照組，差異均有統計學意義（P<0.05）;研究組不良反應發生率為9.52%，對照組為14.63%，差異無統計學意義（P>0.05）。結論：氯呲格雷聯合尿激酶治療AMI可顯著提高臨床療效，糾正凝血功能紊亂，抑制炎癥反應，且安全性較高，可臨床推廣。

【關鍵詞】 急性心肌梗死 氯呲格雷 尿激酶 炎癥反應

doi：10.14033/j.cnki.cfmr.2020.16.005 文獻標識碼 A 文章編號 1674-6805（2020）16-00-03

The Effect of Clopidogrel Combined with Urokinase in Treatment of AMI and Its Effect on Coagulation and Inflammation/LIN Kanghua， HUANG Feilong. //Chinese and Foreign Medical Research， 2020， 18（16）： -15

[Abstract] Objective： To study the effect of Clopidogrel combined with Urokinase on acute myocardial infarction （AMI） and its inflammatory level. Method： A total of 83 patients with AMI who were treated in our hospital from May 2018 to August 2019 were divided into the control group （41 cases） and the study group （42 cases） according to the random number table method. The control group was treated with Urokinase and Aspirin， and the study group was treated with Urokinase and Clopidogrel. The clinical effective rate， coagulation function， inflammation level and the incidence of adverse reactions were observed. Result： The clinical effective rate in the study group was 90.48%， significantly higher than 80.49% in the control group， the difference was statistically significant （P<0.05）. After treatment， The platelet aggregation rate （PAG） in the study group was lower than that in the control group， the activated partial thromboplastin time （APTT） and prothrombin time （PT） were longer than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the C-reactive protein （CRP）， creatine kinase isoenzyme MB subtype （CK-MB） and troponin T （TnT） in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. The adverse reactions were 9.52% in the study group and 14.63% in the control group， there was no significant difference （P>0.05）. Conclusion： Clopidogrel combined with Urokinase in treatment of AMI can significantly improve the clinical efficacy， correct the coagulation disorder， inhibit the inflammatory response， and has high safety， which can be widely used in clinical practice.

[Key words] Acute myocardial infarction Clopidogrel Urokinase Inflammatory response

First-authors address： Wuchuan Peoples Hospital， Wuchuan 524500， China

急性心肌梗死（acute myocardial infarction，AMI）系冠狀動脈粥樣斑塊破裂堵塞冠狀動脈，導致冠狀動脈急性、持續性缺血缺氧所引起的心肌壞死，發病率、致死率均較高，可嚴重影響患者生活，治療原則為溶栓抗凝[1]。常規臨床治療方案為尿激酶聯合阿司匹林，其中尿激酶為靜脈溶栓劑，可恢復冠狀動脈血流、改善心肌缺血缺氧，阿司匹林可通過阻斷花生四烯酸轉變為血栓素A2從而抑制血小板聚集，但因其抗凝作用較弱，二者聯用無法有效糾正凝血紊亂，心肌缺血缺氧性炎性損傷仍較為嚴重，臨床療效欠佳[2]。氯呲格雷為ADP受體拮抗劑，可與血小板表面P2Y12受體特異性結合，具有顯著的抗凝效果[3]，提示氯呲格雷聯合尿激酶治療AMI或許可以取得較好的臨床療效。本研究選取在筆者所在醫院就診的AMI患者開展氯呲格雷聯合尿激酶治療效果研究分析，現作如下報道。……