目的 分析氯吡格雷联合阿司匹林对老年稳定型心绞痛的疗效及远期预后的影响。方法 选取2013-09至2016-09西部战区总医院180例老年稳定型心绞痛患者作为研究对象,根据入院顺序将患者分为研究组和对照组,每组90例。对照组在常规治疗基础上给予口服阿司匹林肠溶片(100 mg/d)进行治疗,研究组在对照组疗法基础上口服硫酸氢氯吡格雷片(75 mg/d)进行治疗。两组均连续给予抗血小板治疗3个月。检测并比较两组治疗前、后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板凝集率(PAR)、左心室射血分数(LVEF)、每搏输出量(SV)及血浆D二聚体(D-D)、纤维蛋白原(FIB);进行2年的随访,对两组治疗期间不良反应发生率、不稳定型心绞痛、心肌梗死、心源性猝死等心血管事件发生率、无心血管事件生存期进行对比分析。结果 治疗后,两组的PT、APTT、LVEF、SV水平均较治疗前升高,FAR、D-D、FIB水平均较治疗前降低,差异有统计学意义(P<0.05),研究组PT、APTT、LVEF、SV水平均高于对照组,FAR、D-D、FIB水平均低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率的差异无统计学意义。在随访发现,两组的心血管事件发生率、平均无心血管事件生存期的差异无统计学意义。结论 老年稳定型心绞痛治疗中应用氯吡格雷联合阿司匹林,能够提高抗血小板治疗效果,降低凝血系统活性,具有较高的安全性。对于患者远期预后的改善作用还需要进一步研究。

Objective To analyze the influence of clopidogrel combined with aspirin on the long-term prognosis and its therapeutic effects against stable angina pectoris in elderly patients. Methods One hundred and eighty elderly patients with stable angina pectoris were selected as the subjects. According to the patients’ wishes and admission sequence numbers, the patients were equally divided into the study group and the control group. Patients in both groups received routine symptomatic treatments. However, those in the control group were given oral aspirin enteric-coated tablets, while those in the study group were treated with oral aspirin enteric-coated tablets (100 mg per day)plus clopidogrel bisulfate tablets (75 mg per day). Both groups received three-month antiplatelet therapy. The prothrombin time (PT), activated partial thromboplastin time (APTT), platelet aggregation rate (PAR), left ventricular ejection fraction (LVEF), stroke volume (SV) and the plasma D-dimer (D-D), fibrinogen (FIB) levels before and after treatment were measured and compared between the two groups. The incidence of adverse reactions during treatment, that of cardiovascular events such as unstable angina pectoris, myocardial infarction, sudden cardiac death, and the survival time without cardiovascular events were also analyzed and compared between the two groups. Results After treatment, levels of PT, APTT, LVEF and SV were elevated in both groups, while levels of FAR, D-D and FIB were lower. The difference was statistically significant (P<0.05). Levels of PT, APTT, LVEF and SV in the study group were higher than those in the control group, but FAR, D-D and FIB levels were lower, and there was statistically significant difference between the two groups (P<0.05). However, there was no statistically significant difference in the incidence of adverse reactions between the two groups. During the follow-up, there was no significant difference in the incidence of cardiovascular events or the mean survival time without cardiovascular events between the two groups. Conclusions Compared with the use of aspirin alone, clopidogrel combined with aspirin used in the treatment of elderly patients with stable angina pectoris can significantly improve the antiplatelet therapeutic effect, reduce the activity of the coagulation system, improve myocardial function, and is safe, but the influence on the improvement of long-term prognosis needs to be further studied.