目的 探討重組組織型纖溶酶原激活劑（r-TPA）聯(lián)合氯吡格雷治療老年急性冠狀動(dòng)脈綜合征（ACS）的臨床療效。方法 選取2012年1月-2013年12月北京市朝陽區(qū)王四營社區(qū)衛(wèi)生服務(wù)中心老年ACS患者92例，隨機(jī)分為治療組和對(duì)照組，每組各46例。兩組患者均在入院后立刻口服300 mg硫酸氯吡格雷片，隨后以75 mg/d的劑量維持服用。對(duì)照組同時(shí)給予注射用尿激酶1.5×10⁶ U加入100 mL生理鹽水中靜脈滴注30 min，2次/d。治療組給予r-TPA注射粉劑，15 mg加生理鹽水靜脈推注，其后30 min內(nèi)靜脈滴注50 mg加生理鹽水，剩余35 mg加生理鹽水在60 min內(nèi)靜脈滴注。兩組均連續(xù)治療5 d。觀察兩組的臨床療效，比較兩組患者治療前后舒張期室間隔厚度（IVST）、左心室射血分?jǐn)?shù)（LVEF）、左室舒張末內(nèi)徑（LVDD）、P-選擇素、血管性假血友病因子（vWF）的變化。結(jié)果 治療組和對(duì)照組的總有效率分別為93.48%、78.26%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者IVST、LVDD、P-選擇素、vWF指標(biāo)均較治療前顯著降低，同組治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05），治療后治療組的這些觀察指標(biāo)均較對(duì)照組降低更加明顯，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者LVEF均較治療前顯著升高，同組治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且治療組高于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 r-TPA聯(lián)合氯吡格雷對(duì)老年ACS患者具有較好的臨床療效，安全有效，值得臨床推廣應(yīng)用。

Objective To observe the clinical efficacy of recombinant tissue-type plasminogen activator (r-TPA) combined with clopidogrel in the treatment of elderly acute coronary syndrome (ACS). Methods Elderly ACS patients (92 cases) of Wangsiying Community Health Service Center of Chaoyang District in Beijing from January 2012 to December 2013 were randomly divided into treatment and control groups, and each group had 46 cases. The patients in the two groups were po administered with Clopidogrel Sulfate Tablets immediately after admission, then kept taking with the dosage of 75 mg/d. Patients in the control group were given Urokinase for injection 1.5×10⁶ U by adding in normal saline (100 mL) slowly dripping for 30 min, twice daily. Patients in the treatment group were given r-TPA Injection Powder, 15 mg by adding in normal saline for intravenous injection, and 50 mg by adding in normal saline within 30 min for intravenous drip, then the remaining 35 mg by adding in normal saline for intravenous drip within 60 min. The patients in the two groups were treated continuously for 5 d. The total clinical efficacy was observed, including the changes of diastolic ventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD),P-select element, and false von willebrand factor (vWF). Results The total effective rates for the patients in the treatment and control groups were 93.48% and 78.26%, respectively, with the significant difference between the two groups (P < 0.05). After the treatment, IVST, LVDD, P-select element, and vWF were more significantly reduced than those before the treatment in the two groups, and the differences were statistically significant in the same group before and after the treatment (P < 0.05). These observational indexes in the treatment group were relatively lower than those in the control group, with the significant difference between the two groups (P < 0.05). After the treatment, LVEF in the two groups was significantly elevated, and the differences were statistically significant in the same group before and after the treatment (P < 0.05 ), while was higher in the treatment group than in the control group, with the significant difference between the two groups (P < 0.05). Conclusion r-TPA combined with clopidogrel has a good clinical efficacy in the treatment of elderly ACS, and it is safe and effective, which is worthy of clinical application.

國家自然科學(xué)基金資助項(xiàng)目（81070169）