不同剂量替罗非班联合地尔硫卓对高危不稳定型心绞痛近期和远期预后的影响

陈志恒; 张燕霞; 刘正丽

doi:10.7619/jcmp.20221632

不同剂量替罗非班联合地尔硫卓对高危不稳定型心绞痛近期和远期预后的影响

湖北省武汉市江夏区第一人民医院, 湖北武汉, 430000

详细信息

通讯作者:
刘正丽, E-mail: zahuaa646@126.com

中图分类号: R541;R749.053
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出版历程
- 收稿日期: 2022-05-22
- 网络出版日期: 2022-11-03

Effects of different doses of tirofiban combined with diltiazem on long-term and short-term prognosis of high-risk unstable angina pectoris

the First People's Hospital of Jiangxia District in Wuhan City of Hubei Province, Wuhan, Hubei, 430000

摘要

摘要:
目的
探讨不同剂量替罗非班联合地尔硫卓对高危不稳定型心绞痛(UAP)近期和远期预后的影响。
方法
随机选取心绞痛患者100例，根据治疗方法不同分为观察组50例和对照组50例。对照组选用常规剂量替罗非班联合地尔硫卓治疗，观察组给予小剂量替罗非班联合地尔硫卓治疗。比较2组不良反应、血液流变学指标、血脂水平[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、心功能指标[脑钠肽(BNP)、左室射血分数(LVEF)]及随访6个月后心绞痛发作情况。
结果
治疗后, 2组血清TC、TG、LDL-C、血浆黏度、红细胞压积、红细胞沉降率、BNP水平均低于治疗前, HDL-C、LVEF水平均高于治疗前，差异有统计学意义(P < 0.05); 治疗后，与对照组比较，观察组患者血清TC、TG、LDL-C、血浆黏度、红细胞压积、红细胞沉降率、BNP水平较低, HDL-C、LVEF水平较高，差异有统计学意义(P < 0.05); 6个月后, 2组患者心绞痛持续时间缩短，发作次数减少，且观察组心绞痛持续时间短于对照组，发作次数少于对照组，差异均有统计学意义(P < 0.05); 治疗后，观察组不良反应总发生率(4.00%)低于对照组(16.00%), 差异有统计学意义(P < 0.05)。
结论
小剂量替罗非班联合地尔硫卓可提升高危UAP患者的心功能，减少心绞痛次数，减轻疼痛程度，有效调节血脂水平，改善血液流变学。
- 替罗非班 /
- 地尔硫卓 /
- 高危不稳定型心绞痛 /
- 疼痛 /
- 血脂水平
Abstract:
Objective
To investigate effects of different doses of tirofiban combined with diltiazem on long-term and short-term prognosis of high-risk unstable angina pectoris(UAP).
Methods
A total of 100 patients with angina pectoris were randomly selected and divided into observation group (n=50) and control group (n=50) according to different treatment methods. The control group was treated with conventional dose of tirofiban combined with diltiazem, and the observation group was treated with low dose tirofiban combined with diltiazem. Occurrence of adverse reactions, hemorheology, blood lipid levels[total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)] and heart function indexes[brain sodium peptide(BNP), left ventricular ejection fraction (LVEF)] and angina pectoris attack after 6 months of follow-up were compared.
Results
After treatment, the serum TC, TG, LDL-C, plasma viscosity, hematokrit, erythrocyte sedimentation rate and BNP levels in both groups were lower than those before treatment, and the levels of HDL-C and LVEF were higher than before treatment (P < 0.05); compared with the control group, the serum TC, TG, LDL-C, plasma viscosity, hematokrit, red blood cell sedimentation rate, and BNP level in the observation group were lower, and HDL-C and LVEF levels were higher after treatment (P < 0.05); after 6 months, the duration of angina pectoris was shorter, and the number of episodes was decreased in both groups (P < 0.05); the duration of angina pectoris in the observation group was shorter than that of control group, and the number of attacks was less than that in the control group(P < 0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group (16.00% versus 4.00%, P < 0.05).
Conclusion
Low-dose tirofiban combined with diltiazem can improve cardiac function of high-risk UAP patients, reduce the frequency of angina pectoris, effectively regulate blood lipid levels and improve hemorheology.
- tirofiban /
- diltiazem /
- high-risk unstable angina /
- pain /
- lipid levels

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表 1 2组血脂水平比较(x±s) mmol/L

组别	n	TC		TG		LDL-C		HDL-C
组别	n	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	50	5.14±1.66	4.14±0.36^*	2.06±0.30	1.85±0.70^*	3.85±0.53	2.58±0.41^*	0.86±0.04	1.26±0.17^*
观察组	50	5.10±1.84	2.34±0.30^*#	2.05±0.41	1.35±0.71^*#	3.75±0.66	1.82±0.34^*#	0.87±0.05	1.71±0.14^*#
TC: 总胆固醇; TG: 甘油三酯; LDL-C: 低密度脂蛋白胆固醇; HDL-C: 高密度脂蛋白胆固醇。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。

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表 2 2组患者血液流变学情况比较(x±s)

组别	n	血浆黏度/(mPa·s)		红细胞压积/%		红细胞沉降率/(mm/h)
组别	n	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	50	2.95±0.33	2.60±0.18^*	27.22±1.34	23.12±1.77^*	43.88±1.15	41.49±1.30^*
观察组	50	3.01±0.28	2.01±0.20^*#	27.35±1.43	16.25±2.00^*#	44.25±1.23	34.52±0.58^*#
与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。

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表 3 2组心功能相关指标水平变化比较(x±s)

组别	n	LVEF/%		BNP/(ng/mL)
组别	n	治疗前	治疗后	治疗前	治疗后
对照组	50	45.85±5.03	50.85±3.25^*	358.87±44.25	146.23±24.70^*
观察组	50	45.40±5.09	56.25±4.42^*#	359.14±45.12	101.20±20.54^*#
BNP: 脑钠肽; LVEF: 左室射血分数。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。

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表 4 2组患者心绞痛发作情况比较(x±s)

组别	n	每次心绞痛持续时间/min		每周心绞痛发作次数/次
组别	n	治疗前	随访6个月后	治疗前	随访6个月后
对照组	50	5.15±1.04	3.95±0.85^*	9.65±1.68	4.89±0.71^*
观察组	50	5.17±1.09	2.23±0.40^*#	9.73±1.57	2.13±0.32^*#
与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。

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2.	张富山，张宇，蔡俊，黄建领，赵俊涛，刘广文，张伟峰. 地尔硫卓对冠心病心绞痛患者冠状动脉血流储备与血管内皮的影响. 中国循证心血管医学杂志. 2023(03): 325-328 . 百度学术
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