小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者的疗效及安全性评价

doi:10.3760/cma.j.issn.1007-1245.2023.04.025

摘要/Abstract

摘要：

目的　研究小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者的疗效及安全性。方法　选取2019年4月至2021年11月山丹县人民医院收治的96例冠心病心绞痛患者为研究对象，采用随机数字表法将患者分为常规组和试验组，每组各48例。常规组中男30例、女18例，年龄47～76（61.55±7.31）岁，采用氯吡格雷治疗；试验组中男29例、女19例，年龄46～77（62.35±6.89）岁，采用小剂量硝酸甘油（0.2 mg/次）联合氯吡格雷治疗。比较两组临床疗效、治疗前、治疗3个月后心绞痛发作情况、心功能指标［舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值（E/A）、射血分数（EF）、心排出量（CO）、心脏指数（CI）］、血小板颗粒膜蛋白（GMP140）、高迁移率族蛋白B1（HMGB1）、白细胞介素-18（IL-18）、C反应蛋白（CRP）水平及不良反应。统计学方法采用t检验、χ²检验。结果　试验组总有效率为95.83%（46/48），高于常规组［81.25%（39/48）］，差异有统计学意义（χ²=5.031，P=0.025）；治疗3个月后试验组心绞痛发作次数、发作持续时间低于常规组［（0.47±0.12）次/d比（0.68±0.19）次/d、（3.25±1.03）min比（6.17±1.22）min］，差异均有统计学意义（t=6.474、12.670，均P<0.05）；治疗3个月后试验组E/A、EF、CO、CI均高于常规组（t=3.458、7.261、3.997、3.472，均P<0.05）；治疗3个月后试验组血清GMP140、HMGB1、IL-18、CRP水平低于常规组（t=7.099、8.729、9.721、5.171，均P<0.05）；试验组不良反应总发生率为10.42%（5/48），与常规组［6.25%（3/48）］相比，差异无统计学意义（χ²=0.136，P=0.712）。结论　小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者可进一步提升疗效，可有效缩短心绞痛发作时间，改善心功能，促进病情恢复，且安全性高。

关键词:

小剂量硝酸甘油, 冠心病心绞痛, 氯吡格雷, 安全性

Abstract:

Objective　To study the efficacy and safety of low-dose nitroglycerin combined with clopidogrel in the treatment of patients with coronary heart disease and angina pectoris. Methods　Ninety-six patients with coronary heart disease and angina pectoris treated in Shandan County People's Hospital from April 2019 to November 2021 were selected as the research objects. The patients were divided into a routine group and an experimental group by the random number table method, with 48 cases in each group. There were 30 males and 18 females in the routine group; they were 47-76 (61.55±7.31) years old. There were 29 males and 19 females in the experimental group; they were 47-77 (62.35±6.89) years old. The routine group were treated with clopidogrel, and the experimental group with low-dose nitroglycerin (0.2 mg/time) and clopidogrel. The clinical efficacies, angina attack, cardiac function indicators [ratio of early diastolic mitral valve blood flow velocity to late diastolic mitral valve blood flow velocity (E/A), ejection fraction (EF), cardiac output (CO), and cardiac index (CI)], and levels of platelet granule membrane protein (GMP140), high mobility group box protein B1 (HMGB1), interleukin-18 (IL-18), and C-reactive protein (CRP) before and 3 months after the treatment, and adverse reactions were compared between these two groups. t and χ² tests were applied. Results　The total effective rate of the experimental group was higher than that of the routine group [95.83% (46/48) vs. 81.25% (39/48)], with a statistical difference (χ²=5.031, P=0.025). Three months after the treatment, the frequency and duration of angina pectoris in the experimental group were lower than those in the conventional group [(0.47±0.12)time/d vs. (0.68±0.19) time/d and (3.25±1.03) min vs. (6.17±1.22) min], with statistical differences (t=6.474 and 12.670; both P<0.05). Three months after the treatment, the E/A, EF, CO, and CI in the experimental group were higher than those in the routine group (t=3.458, 7.261, 3.997, and 3.472; all P<0.05). Three months after the treatment, the serum levels of GMP140, HMGB1, IL-18, and CRP in the experimental group were lower than those in the routine group (t=7.099, 8.729, 9.721, and 5.171; all P<0.05). The total incidences of adverse reactions in the experimental group and the routine group were 10.42% (5/48) and 6.25% (3/48), respectively, with no statistical difference (χ²=0.136, P=0.712). Conclusion　Low-dose nitroglycerin combined with clopidogrel in the treatment of patients with coronary heart disease and angina pectoris can further improve the efficacy and their cardiac function and recovery, and effectively shorten the attack time of angina pectoris, with high safety.

Key words:

Low-dose nitroglycerin, Coronary heart disease and angina pectoris, Clopidogrel, Safety

刘晓卉.

小剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛患者的疗效及安全性评价 [J]. 国际医药卫生导报, 2023, 29(4): 549-553.

Liu Xiaohui.

Efficacy and safety evaluation of low-dose nitroglycerin combined with clopidogrel for patients with coronary heart disease and angina pectoris [J]. International Medicine and Health Guidance News, 2023, 29(4): 549-553.

参考文献

[1] Arroyo-Quiroz C,Barrientos-Gutierrez T,O'Flaherty M,et al.Coronary heart disease mortality is decreasing in Argentina, and Colombia, but keeps increasing in Mexico: a time trend study[J].BMC Public Health,2020,20(1):162.DOI:10.1186/s12889-020-8297-5.
[2] «国际医药卫生导报»编辑部.慢性病的治与防[J].国际医药卫生导报,2018,24(15):2219.DOI:10.3760/j.issn. 1007-1245.2018.15.001.
[3] Watanabe H,Domei T,Morimoto T,et al.Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial[J].JAMA,2019,321(24):2414-2427.DOI:10.1001/jama.2019.8145.
[4] 邢寻静,秦玲,唐明龙,等.替格瑞洛和氯吡格雷在老年冠心病患者抗血小板治疗中有效性及安全性的Meta分析[J].吉林大学学报(医学版),2019,45(1):123-129.DOI:10.13481/j.1671-587x.20190123.
[5] 崔英慧.不同剂量硝酸甘油联合氯吡格雷治疗冠心病心绞痛的比较研究[J].河北医药,2019,41(17):2678-2680,2684.DOI:10.3969/j.issn.1002-7386.2019.17.030.
[6] Balaban Y,Kaya A,Satilmisoglu MH,et al. Intracoronary focal nitroglycerin injection through drilled balloon is very effective in the resolution of coronary spasm versus into proximal coronary artery: a prospective randomized comparison study[J].J Interv Cardiol,2018,31(6):765-774.DOI:10.1111/joic.12542.
[7] 高润霖.进一步改善稳定性冠心病的诊治:浅谈"中国稳定性冠心病诊断与治疗指南"亮点[J].中华心血管病杂志,2018,46(11):833-836.DOI:10.3760/cma.j.issn. 0253-3758. 2018.11.002.
[8] Roberts WC.Quantitative extent of atherosclerotic plaque in the major epicardial coronary arteries in patients with fatal coronary heart disease, in coronary endarterectomy specimens, in aorta-coronary saphenous venous conduits, and means to prevent the plaques: a review after studying the coronary arteries for 50 years[J].Am J Cardiol,2018,121(11):1413-1435.DOI:10.1016/j.amjcard.2018.02.017.
[9] 秦斌,王飞,张文静.阿托伐他汀联合氯吡格雷在冠心病心绞痛治疗中对血脂、血液流变学及心功能影响[J].临床军医杂志,2021,49(1):92-94.DOI:10.16680/j.1671-3826. 2021.01.32.
[10] 陈华华.氯吡格雷联合瑞舒伐他汀治疗冠心病心绞痛的效果及安全性回顾性分析[J].中国药物与临床,2020,20(19):3257-3258.DOI:10.11655/zgywylc2020.19.041.
[11] 陈晓红,张勇,陈秀红.舒冠颗粒联合氯吡格雷治疗冠心病心绞痛的临床研究[J].现代药物与临床,2020,35(5):923-926.DOI:10.7501/j.issn.1674-5515.2020.05.021.
[12] 白志冬,乔树洲,党涛,等.硝酸甘油联合冠心丹参滴丸治疗老年冠脉支架术后稳定性心绞痛的临床疗效[J].西北国防医学杂志,2020,41(5):303-306.DOI:10.16021/j.cnki. 1007-8622.2020.05.009.
[13] 孟庆槐,张洪亮.丹参川芎嗪联合硝酸甘油治疗冠心病心绞痛的疗效及对血清BNP、CRP的影响[J].中西医结合心脑血管病杂志,2018,16(7):893-896.DOI:10.12102/j.issn. 1672-1349.2018.07.018.
[14] 孙静,刘涛,吕彦.硝酸甘油联合舒胸益气汤治疗冠心病心绞痛的疗效观察[J].中西医结合心脑血管病杂志,2019,17(9):1383-1385.DOI:10.12102/j.issn.1672-1349.2019. 09.028.
[15] 叶智勇,郑夏妹,郑尚荣,等.阿司匹林肠溶片联合他汀类药物治疗冠心病心绞痛的效果[J].中国临床保健杂志,2019,22(6):842-845.DOI:10.3969/J.issn.1672-6790.2019. 06.032.
[16] 郭红玲,欧阳艳红,王圣,等.灯盏生脉胶囊联合单硝酸异山梨酯缓释片对老年冠心病心绞痛患者心功能、血脂及血清IL-6、CRP水平的影响[J].现代生物医学进展,2021,21(12):2373-2376,2339.DOI:10.13241/j.cnki.pmb. 2021.12.038.
[17] 苏学旭,仲秀艳,王劲红,等.芪蛭三七汤治疗冠心病稳定型心绞痛气虚血瘀证的疗效及对患者凝血功能和心功能的影响[J].现代生物医学进展,2019,19(5):951-955.DOI:10.13241/j.cnki.pmb.2019.05.035.
[18] 沈奇峰,周茂生,刘江.老年原发性微血管心绞痛患者FPA和GMP-140水平的变化及临床意义[J].浙江医学,2022,44(2):184-186.DOI:10.12056/j.issn.1006-2785.2022. 44.2. 2021-3309.
[19] 王丹.冠心病PCI术患者HMGB1、BNP水平变化及与发生心力衰竭的关系[J].河北医药,2019,41(2):199-202.DOI:10.3969/j.issn.1002-7386.2019.02.009.
[20] 陈曼丽,宫蕊,齐莉莉,等.丹红注射液联合麝香保心丸治疗冠心病心绞痛疗效及对患者NF-κB、GMP-140的影响[J].陕西中医,2020,41(3):321-323. DOI:10.3969/j.issn. 1000-7369.2020.03.014.