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曾倩倩,徐琛华,严健华,焦昆立,蔺艳军,徐全福*,孟舒*.抗血小板药物替格瑞洛临床相关呼吸困难的危险因素分析[J].Academic Journal of Second Military Medical University ,2021,42(9):988-996
抗血小板药物替格瑞洛临床相关呼吸困难的危险因素分析    点此下载全文 Fulltext
曾倩倩  徐琛华  严健华  焦昆立  蔺艳军  徐全福*  孟舒*
上海交通大学医学院附属新华医院心血管内科, 上海 200092
*通信作者
基金项目:上海市卫生健康委员会科研课题[ZT (2018-2020)-FWTX-3027],上海交通大学医学院科研课题(TM201811).
DOI:10.16781/j.0258-879x.2021.09.0988
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摘要:
      目的 探讨经皮冠状动脉介入(PCI)治疗的急性冠状动脉综合征(ACS)患者服用抗血小板药物替格瑞洛后出现呼吸困难的危险因素。方法 采用回顾性研究和前瞻性研究相结合的方法。回顾性纳入2016年1月至2019年11月上海交通大学附属新华医院心血管内科收治的418例接受PCI治疗后服用替格瑞洛的ACS患者,根据呼吸困难发生情况将患者分为替格瑞洛相关呼吸困难组和未发生呼吸困难组,收集并比较两组患者的临床及实验室检查资料。在前瞻性研究中选择2020年1月至8月上海交通大学附属新华医院心血管内科收治的PCI术后服用替格瑞洛的ACS患者367例,根据回顾性研究结果并参照临床指南将患者分为低密度脂蛋白胆固醇(LDL-C)组(LDL-C<2.6 mmol/L)和高LDL-C组(LDL-C≥2.6 mmol/L),比较两组患者资料,并采用多因素logistic回归分析替格瑞洛相关呼吸困难的危险因素。结果 回顾性研究的418例ACS患者中71例(17.0%)发生替格瑞洛相关呼吸困难。与未发生呼吸困难组相比,替格瑞洛相关呼吸困难组的出血事件更多[23.9%(17/71)vs 10.1%(35/347),P=0.001]、LDL-C水平更高[(2.54±0.88)mmol/L vs(2.32±0.81)mmol/L,P=0.045]。多因素logistic回归分析结果显示出血事件(OR=3.128,95%CI 1.613~6.065,P=0.001)、LDL-C升高(OR=1.451,95%CI 1.071~1.964,P=0.016)是PCI术后ACS患者发生替格瑞洛相关呼吸困难的危险因素。前瞻性研究的367例ACS患者中64例(17.4%)发生替格瑞洛相关呼吸困难。高LDL-C组患者替格瑞洛相关呼吸困难的发生率高于低LDL-C组[23.4%(33/141)vs 13.7%(31/226),P=0.018],同时两组在吸烟史、PCI史、心肌梗死史、超敏CRP、空腹血糖、总胆固醇、总甘油三酯、高密度脂蛋白胆固醇、左心室射血分数、植入支架数目方面的差异均有统计学意义(P均<0.05)。经多因素logistic回归分析发现吸烟史是PCI术后ACS患者发生替格瑞洛相关呼吸困难的独立预测因素(OR=2.695,95%CI 1.236~5.878,P=0.013)。结论 PCI术后服用替格瑞洛的ACS患者呼吸困难的发生率为17.4%(64/367),血清LDL-C≥2.6 mmol/L的PCI术后ACS患者服用替格瑞洛后呼吸困难发生率更高,吸烟史是替格瑞洛相关呼吸困难的独立预测因素。
关键词:替格瑞洛  呼吸困难  急性冠状动脉综合征  低密度脂蛋白胆固醇  危险因素
Analysis of risk factors for clinical dyspnea related to antiplatelet drug ticagrelor    Fulltext
ZENG Qian-qian  XU Chen-hua  YAN Jian-hua  JIAO Kun-li  LIN Yan-jun  XU Quan-fu*  MENG Shu*
Department of Cardiovasology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
*Corresponding authors
Fund Project:
Abstract:
      Objective To investigate the risk factors of dyspnea in acute coronary syndrome (ACS) patients taking antiplatelet drug ticagrelor after percutaneous coronary intervention (PCI). Methods A combination of retrospective and prospective studies was used. A total of 418 ACS patients taking ticagrelor after PCI in the Department of Cardiovasology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jan. 2016 to Nov. 2019 were retrospectively included. According to the incidence of dyspnea, the patients were divided into ticagrelor-related dyspnea group and non-dyspnea group. The clinical and laboratory data were collected and compared. In the prospective study, 367 ACS patients taking ticagrelor after PCI in the Department of Cardiovasology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jan. to Aug. 2020 were selected. Based on the results of retrospective study and guidelines, the patients were divided into low low-density lipoprotein-cholesterol (LDL-C) group (LDL-C<2.6 mmol/L) and high LDL-C group (LDL-C ≥ 2.6 mmol/L), The clinical data were compared, and the risk factors of ticagrelor-related dyspnea were further analyzed using multiple logistic regression. Results Of the 418 ACS patients in the retrospective study, 71 (17.0%) had ticagrelor-related dyspnea. The ticagrelor-related dyspnea group had more bleeding events (23.9%[17/71] vs 10.1%[35/347], P=0.001) and higher LDL-C level ([2.54±0.88] mmol/L vs[2.32±0.81] mmol/L, P=0.045) compared with the non-dyspnea group. Multiple logistic regression analysis showed that bleeding events (odds ratio[OR]=3.128, 95% confidence interval[CI]1.613-6.065, P=0.001) and elevated LDL-C (OR=1.451, 95% CI 1.071-1.964, P=0.016) were the risk factors of ticagrelor-related dyspnea. Of the 367 ACS patients in the prospective study, 64 (17.4%) had ticagrelor-related dyspnea. The incidence of ticagrelor-related dyspnea was higher in the high LDL-C group than that in the low LDL-C group (23.4%[33/141] vs 13.7%[31/226], P=0.018). At the same time, there were significant differences in the history of smoking, PCI and myocardial infarction, the levels of hypersensitive C reactive protein, fasting blood glucose, total cholesterol, total triglyceride, high-density lipoprotein-cholesterol, left ventricular ejection fraction, and the number of stent implantation between the 2 groups (all P<0.05). Multiple logistic regression analysis showed that smoking history was an independent predictor of ticagrelor-related dyspnea (OR=2.695, 95% CI 1.236-5.878, P=0.013). Conclusion The incidence of dyspnea in ACS patients taking ticagrelor after PCI is 17.4% (64/367). The ACS patients after PCI with serum LDL-C ≥ 2.6 mmol/L are prone to ticagrelor-related dyspnea. Smoking history is an independent predictor of ticagrelor-related dyspnea.
Keywords:ticagrelor  dyspnea  acute coronary syndrome  low-density lipoprotein-cholesterol  risk factors
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