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目的:探讨氯吡格雷用于冠心病合并糖尿病患者行冠脉介入治疗后对YKL-40、NF-κB的影响。方法选择2013年8月—2016年12月在西宁市第一人民医院进行经皮冠脉介入治疗手术的冠心病合并糖尿病患者80例,随机分为两组,每组40例,对照组患者围术期接受阿司匹林治疗,观察组患者在对照组基础上接受氯吡格雷治疗,服用3~5 d后进行经皮冠脉介入治疗,术后持续治疗1个月后评价疗效。比较两组患者治疗7 d后的血小板聚集情况;治疗1个月后评价两组患者治疗后的临床疗效,分别检测并分析两组患者治疗前后的几丁质酶-3样蛋白-1(YKL-40)以及转录因子-κB(NF-κB)含量水平,记录并分析两组患者围术期不良反应事件的发生情况。结果手术7 d后,观察组的血小板聚集率显著低于对照组,差异有统计学意义(P<0.05)。治疗1个月后,观察组的临床疗效显著高于对照组,差异有统计学意义(P<0.05)。两组患者经过治疗后,YKL-40以及NF-κB较治疗前均显著降低,差异有统计学意义(P<0.05);且观察组显著低于对照组,差异有统计学意义(P<0.05)。两组患者发生血小板减少、消化道出血等不良事件发生率的差异无统计学意义;观察组发生心肌梗死、心绞痛、死亡等心血管不良事件的发生率虽然低于对照组,但是差异无统计学意义;观察组患者不良反应的总发生率显著低于对照组,差异有统计学意义(P<0.05)。结论氯吡格雷联合阿司匹林用于冠心病合并糖尿病患者围术期的抗血小板治疗,临床疗效较好,可有效控制患者体内炎症反应,降低不良事件的发生率,安全性较好,值得临床推广应用。
Objective: To investigate the effect of clopidogrel on coronary artery disease with diabetes mellitus after coronary intervention on the YKL-40, NF-κB. Methods Eighty patients with coronary heart disease complicated with diabetes treated by percutaneous coronary intervention in the First People’s Hospital of Xining City from August 2013 to December 2016 were randomly divided into two groups with 40 cases in each group and the control group Patients in the observation group received clopidogrel on the basis of the control group. Patients in the observation group received percutaneous coronary intervention 3 to 5 days after operation, and the therapeutic effect was evaluated after 1 month of continuous treatment. The platelet aggregation was compared between the two groups after 7 days of treatment. After 1 month of treatment, the clinical efficacy of the two groups after treatment was evaluated. The levels of cholinergic-3-like protein-1 (YKL -40) and the level of transcription factor-κB (NF-κB) were recorded and analyzed. The incidence of perioperative adverse events was recorded and analyzed. Results After 7 days of operation, the platelet aggregation rate in the observation group was significantly lower than that in the control group (P <0.05). After 1 month of treatment, the clinical efficacy of the observation group was significantly higher than that of the control group, the difference was statistically significant (P <0.05). After treatment, the levels of YKL-40 and NF-κB in both groups were significantly lower than those before treatment (P <0.05), and the levels in the observation group were significantly lower than those in the control group (P <0.05 ). There was no significant difference in the incidence of adverse events such as thrombocytopenia and gastrointestinal bleeding between the two groups. Although the incidence of adverse cardiovascular events such as myocardial infarction, angina pectoris and death in the observation group was lower than that in the control group, the difference was not statistically significant Significance; The incidence of adverse reactions in observation group was significantly lower than that in control group, the difference was statistically significant (P <0.05). Conclusion Clopidogrel combined with aspirin for perioperative antiplatelet therapy in patients with coronary heart disease and diabetes mellitus has good clinical efficacy, which can effectively control the inflammatory reaction in patients and reduce the incidence of adverse events, which is safe and worthy of clinical application .