目的 探討替羅非班聯(lián)合阿司匹林和氯吡格雷治療糖尿病合并急性心肌梗死的臨床研究。方法 選擇2018年6月—2020年2月在河北港口集團(tuán)有限公司港口醫(yī)院行急診經(jīng)皮冠狀動(dòng)脈介入治療（PCI）的112例糖尿病合并急性心肌梗死患者，將其隨機(jī)分為三聯(lián)組（n=56）和二聯(lián)組（n=56）。二聯(lián)組口服阿司匹林腸溶片300 mg/d和氯吡格雷片300 mg/d，PCI后給予阿司匹林腸溶片100 mg/d和氯吡格雷片75 mg/d，服用6個(gè)月。三聯(lián)組在二聯(lián)組的基礎(chǔ)上靜脈滴注替羅非班注射液，起始0.5 h內(nèi)以0.4 μg/（kg·min）的速率滴注，之后維持滴注的速率變?yōu)?.1 μg/（kg·min）。比較兩組臨床療效、血糖水平［餐后2 h血糖（2 h PG）、空腹血糖（FPG）］、心功能指標(biāo)［左室射血分?jǐn)?shù)（LVEF）、左室短軸縮短分?jǐn)?shù)（LVFS）］、血小板活化參數(shù)（CD62P、CD63）及出血不良事件發(fā)生情況。結(jié)果 治療后，觀察組的總有效率為91.07%，顯著高于對(duì)照組的76.79%（P<0.05）。治療后，兩組患者FPG、2 h PG較治療前差異無(wú)統(tǒng)計(jì)學(xué)意義。治療后，兩組患者LVFS、LVEF較治療前顯著升高（P<0.05）；且三聯(lián)組患者LVFS、LVEF顯著高于二聯(lián)組（P<0.05）。治療后，兩組患者CD62P、CD63較治療前顯著下降（P<0.05）；且三聯(lián)組患者CD62P、CD63顯著低于二聯(lián)組（P<0.05）。兩組出血不良事件發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 替羅非班聯(lián)合阿司匹林和氯吡格雷治療糖尿病合并急性心肌梗死患者短期療效較好，能夠改善患者心功能，降低血小板活化水平，且對(duì)患者的血糖水平無(wú)明顯影響，不會(huì)增加出血不良事件發(fā)生率，值得進(jìn)一步研究和推廣。

Objective To investigate efficacy of tirofiban combined with aspirin and clopidogrel in treatment of diabetes mellitus complicated with acute myocardial infarction. Methods A total of 112 patients with diabetes mellitus complicated with acute myocardial infarction who underwent emergency percutaneous coronary intervention (PCI) in Port Hospital of Hebei Port Group Co., Ltd from June 2018 to February 2020 were selected and randomly divided into triple antiplatelet (n=56) and double antiplatelet group (n=56). Patients in the double antiplatelet group were po administered with Aspirin Enteric-coated Tablets, 300 mg/d and Clopidogrel Tablets 300 mg/d, and 100 mg/d Aspirin Enteric-coated Tablets, 75 mg/d Clopidogrel Tablets were given after PCI for 6 months. Patients in the triple antiplatelet group were iv administered with Tirofiban Injection on the basis of two antiplatelet group at a rate of 0.4 μg/(kg·min) for the first half hour, and then at a rate of 0.1 μg/(kg·min) for maintenance. After treatment, the clinical efficacy, blood glucose level [2 h postprandial blood glucose (2 h PG), fasting blood glucose (FPG)], cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular short axis fraction (LVFS)], platelet activation parameters (CD62P, CD63), and the occurrence of bleeding adverse events were compared between two groups. Results After treatment, the total effective rate of triple group was 91.07%, which was significantly higher than 76.79% of double group, and the difference was statistically significant (P < 0.05). After treatment, there was no significant difference in FPG and 2 h P G between two groups compared with before treatment. After treatment, LVFS and LVEF in two groups were significantly increased compared with before treatment (P < 0.05), and LVFS and LVEF in triple group were significantly higher than those in double group (P < 0.05). After treatment, CD62P and CD63 in two groups were significantly decreased compared with before treatment (P < 0.05), and CD62P and CD63 in triple group were significantly lower than those in double group (P < 0.05). There was no significant difference in the incidence of bleeding adverse events between two groups. Conclusion Tilofiban combined with aspirin and clopidogrel in treatment of patients with diabetes mellitus complicated with acute myocardial infarction has good short-term efficacy, can improve the cardiac function of patients, reduce platelet activation level, and has no significant effect on the blood glucose level of patients, will not increase the incidence of bleeding adverse events, worthy of further research and promotion.

R972

秦皇島市科學(xué)技術(shù)研究與發(fā)展計(jì)劃項(xiàng)目（201703A208）