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半量替格瑞洛对高龄急性冠脉综合征并发慢性肾功能不全患者的疗效和安全性(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第3期
页码:
300-303
栏目:
临床研究
出版日期:
2017-01-25

文章信息/Info

Title:
Efficacy and safety of half-dose ticagrelor in elderly patients with acute coronary syndrome combined with chronic renal insufficiency
作者:
张 亮1; 袁 铭1; 曹 丰2
1.第四军医大学西京医院心血管内科，陕西 西安 710032；2.解放军总医院心内科，北京 100853
Author(s):
ZHANG Liang1;  YUAN Ming1;  CAO Feng2
1.Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China; 2.Department of Cardiology, PLA General Hospital, Beijing 100853, China
关键词:
替格瑞洛; 剂量; 高龄; 急性冠脉综合征; 慢性肾功能不全
Keywords:
ticagrelor;  dose;  advanced age;  acute coronary syndrome;  chronic renal insufficiency
分类号:
R541；R692.5
DOI:
-
文献标识码:
A
摘要:
目的 探讨半剂量替格瑞洛在高龄（>75岁）冠脉综合征(ACS)并发肾功能不全（CRI）患者中的远期疗效及安全性。方法 入选ACS并发CRI的患者93例，分为替格瑞洛全剂量组（n=48例）及半剂量组（n=45）。全剂量组替格瑞洛负荷剂量180 mg，随之90 mg， 2次/d，半剂量组负荷剂量90 mg，随之45 mg ,2次/d。进行记录及临床随访12个月，比较两组患者主要不良心脑血管事件（MACCE））的发生率，出血事件的发生率，及其他不良反应的发生率。结果 两组患者在基线临床资料如年龄、性别、吸烟史、高脂血症、高血压病、肝功能、左室射血分数（LVEF）及肾小球滤过率估计值（eGFR）等均无显著差异，而糖尿病患病率及ST抬高型ACS(STEACS)的发生率在两组之间有显著差异（P<0.05）。随访12个月发现，全剂量组和半剂量组的MACCE事件分别发生9例（19%）和6例（13%），两组之间差异无统计学意义。全剂量组和半剂量组出血事件分别发生16例（33%）和6例（13%），均为轻度出血, 半剂量组出血事件显著少于全剂量组，有显著性统计学差异（P<0.05）,无严重或者致死性出血的发生。呼吸困难在全剂量组和半剂量组的发生率分别为12例(25%)和9例(20%)，呼吸困难均是轻度、可耐受、一过性的,两组之间无显著性统计学差异。结论 半剂量的替格瑞洛对于高龄（>75岁）ACS并发CRI患者中和全剂量替格瑞洛有同样的疗效，并且有较好的安全性。
Abstract:
AIM To evaluate the long-term efficacy and safety of half-dose ticagrelor in elderly patients (>75 years) with acute coronary syndrome (ACS) combined with chronic renal insufficiency (CRI) in China. METHODS Ninety-three patients with ACS combined with CRI were randomly divided into full-dose ticagrelor group, loading dose of 180 mg followed by 90 mg bid (n=48) and half-dose ticagrelor group, loading dose of 90 mg, then 45 mg bid (n=45). Patients were recorded and followed for 12 months and the incidence of major adverse cardiac events, bleeding events and adverse reactions were compared between groups. RESULTS No significant difference was noted in baseline between groups except the prevalence rate of diabetes and the incidence rate of STE-ACS (P<0.05). During the 12-month follow-up, there were nine cases of major adverse cardiac events in full-dose group and six cases in half-dose group, with no significant statistical difference between groups (19% vs. 13%). There were 16 mild cases of bleeding events in the full-dose group and eight cases in the half-dose group. The percentage in half-dose group was significantly lower (13% vs. 33%, P<0.05) and there were no serious or fatal bleeding events in either group. There were 12 case of dyspnea in the full-dose group and nine cases in the half-dose group, with no significant statistical difference between groups (25% vs. 22%). Dyspnea in both groups was mild, tolerable and temporary. CONCLUSION Half-dose ticagrelor achieves the same efficacy as full-dose ticagrelor but half-dose ticagrelor is safer for elderly patients (>75 years) with ACS combined with CRI.

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备注/Memo

备注/Memo:
收稿日期：2016-08-03.通讯作者：袁铭，副教授，主要从事冠心病基础和复杂冠脉介入治疗研究Email:yuanming@fmmu.edu.cn 共同通讯作者：曹丰，教授，主要从事冠心病的诊治和心血管分子影像学研究 Email:fengcao8828@163.com 作者简介：张亮，硕士生 Email:zhangliang199096@163.com
更新日期/Last Update: 2017-02-20