目的 研究氯吡格雷联合低分子肝素对老年急性心肌梗死(acute myocardial infarction, AMI)患者血清中血脂及炎性因子的影响,为临床AMI的治疗提供参考依据。方法 选取新乡医学院第一附属医院于2016年10月—2019年11月期间收治的老年AMI患者112例,按照随机分配的原则分成两组,即对照组和观察组,每组病例各56例,治疗方式为对照组单给予口服氯吡格雷进行治疗,观察组给予口服氯吡格雷与皮下注射低分子肝素联合治疗,比较治疗前后两组患者血清中甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDH-C),炎性因子的水平变化及心功能的改变情况。结果 与治疗前相比较,治疗后对照组和观察组患者血清TG、TC及LDH-C水平均降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平均降低,患者的左心室后壁厚度、左心室舒张末期内径均有降低,射血分数升高;而与对照组治疗后相比较,治疗后观察组患者血清TG、TC及LDH-C水平进一步降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平进一步降低,患者的左心室后壁厚度、左心室舒张末期内径均降低,而射血分数升高,差异有统计学意义。结论 氯吡格雷联合低分子量肝素可通过降低血清中血脂的水平,抑制AMI过程中的炎症反应,减少炎性因子的释放,提高患者的心功能,改善患者的病情。

Objective To explore the effects of clopidogrel combined with low molecular weight heparin on serum lipids and inflammatory factors in elderly patients with acute myocardial infarction, and provide reference for clinical treatment of AMI. Methods 112 elderly patients with AMI admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2016 to November 2019 were randomly divided into control group and observation group,56 cases in each group.The control group was treated with clopidogrel alone, and the observation group was treated with clopidogrel combined with low molecular weight heparin. The levels of serum TG, TC and LDH-C, inflammatory factors and cardiac function were compared between the two groups before and after treatment. Results Compared with before treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased in the observation group and the control group after treatment. The left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased in the observation group and control group after treatment. Compared with control group after treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased, the left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased further in observation group after treatment. Conclusion Clopidogrel combined with low molecular weight heparin may improve the patient's cardiac function, then improve the patient's condition through reducing the level of serum lipids, inhibit the inflammatory reaction in AMI, reduce the release of inflammatory factors.

目的 比较替格瑞洛片与氯吡格雷片在临床住院急性冠状动脉综合征患者使用中的出血风险。方法 选择2016年1月—2016年11月于我院心血管内科住院的264例急性冠状动脉综合征患者。将患者随机分为两组,替格瑞洛组(A组)131例,氯吡格雷组(B组)133例。对两组患者出血情况进行比较。结果 住院期间两组患者均无严重心血管不良事件(MACE),均未见黑便及需要输血的严重出血。轻微出血患者数,A组:17例占13.0%(17/131),B组:3例占2.3%(3/133),A组轻微出血风险高于B组,差异有统计学意义(P＜0.01)。结论 替格瑞洛轻微出血风险发生率高于氯吡格雷,均未见MACE发生及严重出血病例,临床使用中需注意此问题,并建议更多的临床研究出现。

Objective To compare the risk of bleeding between Clopidogrel and Ticagrelor in inpatients with acute coronary syndrome. Methods 264 patients with acute coronary syndrome who were admitted to our hospital from January 2016 to October 2016 were selected. The patients were divided into two groups randomly, 131 cases with taking Ticagrelor tablets and 133 cases with taking Clopidogrel tablets. The risk of bleeding of the two groups were compared. Results There were no serious adverse cardiovascular events (MACE) between two groups. Severe bleeding events were not obsereved in Ticagrelor and Clopidogrel group. The number of cases with mild bleeding were 17 in Ticagrelor group(13%) and 3 in Clopidogrel group (2.3%). The incidence of minor bleeding risk in Ticagrelor group was significantly higher than the Clopidogrel group(P<0.01). Conclusion The incidence of minor bleeding risk in Ticagrelor group was higher than Clopidogrel.There was no MACE occurrence and serious bleeding among two groups. We need to pay more attention to this problem in clinical use, and more clinical research should be proposed.