Efficacy and safety of triple antiplatelet therapy in patients with diabetes mellitus combined with coronary heart disease after percutaneous coronary intervention

目的 观察糖尿病合并冠心病患者经皮冠状动脉介入(PCI)术后三联抗血小板治疗的临床效果及安全性.方法 将166例糖尿病合并冠心病患者按随机数字表分为对照组(80例)和观察组(86例),对照组给予阿司匹林100 mg/d、氯吡格雷75 mg/d;观察组在双联基础上加西洛他唑100 mg/d.记录分析2组基线资料、冠状动脉造影和PCI的结果差异,随访观察2组主要终点和次要终点事件发生率的差异.结果 术后随访观察组最小管腔直径明显高于对照组[(2.76 ±0.53)mm 比(1.35± 0.32) mm,P＜0.05];观察组管腔晚期丢失和再狭窄率均明显低于对照组[(1.28 ±0.33)mm 比(0.71 ±0.23)mm,2.3％(2/86)比11.2％ (9/80),均P＜0.05].随访1个月及1年,观察组主要终点事件发生率明显低于对照组,差异有统计学意义[1个月:2.3％ (2/86)比8.8％ (7/80),P＜0.05;1年:5.8％ (5/86)比11.2％ (1/80),P＜0.05];次要终点发生率比较差异无统计学意义[1个月:1.16％ (2/86)比1.25％ (1/80);1年:2.3％ (2/86)比2.5％ (2/80),P＞0.05].结论 PCI术后预防支架内再狭窄患者氯吡格雷、阿司匹林和西洛他唑三联抗血小板治疗,疗效确切,可进一步降低主要不良心脑血管事件的发生率,同时并不增加出血风险.Objective To observe clinical efficacy and safety of aspirin,clopidogrel and cilostazol antiplatelet therapy in diabetic patients after percutaneous coronary intervention (PCI) in the prevention of stent restenosis.Methods Totally 166 patients with coronary heart disease (CHD) were divided into control group (80 cases) and observation group (86 cases).Control group was given 100 mg/d of aspirin and clopidogrel 75 mg/d.Observation group was given thiazole 100 mg/d on the basis of the control group.The difference of the baseline data,the results of coronary angiography and PCI,the primary end point and the difference of incidence of secondary end point index were recorded.Results Minimal lumen diameter of observation group was obviously higher than that of control group[(2.76 ± 0.53) mm vs (1.35 ± 0.32) mm,P ＜ 0.05].Late lumen loss,restenosis rate in observation group were significantly lower than those in the control group [(1.28 ± 0.33) mm vs (0.71 ±0.23)mm,P ＜0.05].At one month and 12 months follow-ups,the incidence rate of the primary end point index in observation group was significantly lower than that in control group; the difference was statistically significant [1 month:2.3％ (2/86) vs 8.8％ (7/80),2.3％ (2/86) vs 11.2％ (9/80),P＜0.05; 1 year:5.8％ (0/86) vs 11.2％ (1/80),P ＜ 0.05].The incidence of secondary end points had no statistically significant difference [1 month:1.16％ (2/86) vs 1.25％ (1/80) ; 1 year:2.3％ (2/86) vs 2.5％ (2/80),P ＞0.05].Conclusion PCI postoperative prevention of in-stent restenosis in patients with clopidogrel,aspirin and cilostazol can further reduce major adverse cardiovascular event rates and does not increase the risk of bleeding.国家自然科学基金中国科技核心期刊(ISTIC)06774-778