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目的:观察盐酸替罗非班对急性心肌梗死的临床疗效及相应机制。方法:哈尔滨医科大学附属第四医院急诊急救中心入选急性ST段抬高型心肌梗死的患者(n=50),其中男性35例,女性15例,平均年龄58.4±10.3岁,给予内科药物治疗。患者随机分为常规药物组(n=23)和替罗非班组(常规药物+替罗非班,n=27)。通过观察临床症状和心电图ST段变化评价治疗效果,应用血小板聚集仪比浊法测定样本不同时间点(治疗前,给药过程中,给药结束后2小时)血小板聚集率变化以及应用酶联免疫吸附剂测定(ELISA)方法检测血清中血小板第四因子(PF4)的水平变化。并进一步做相关性分析。结果:与常规药物组比较,替罗非班组患者胸痛明显减轻,心电图ST回落指数增加(P<0.05),给药过程中血小板聚集率明显降低(P<0.001),同时血清中PF4的水平也显著降低(P<0.001),并且与血小板聚集率呈正相关性(r=0.86,P<0.001)。结论:盐酸替罗非班对于急性ST段抬高型急性心肌梗死有确切的治疗效果,可能是通过抑制血小板的聚集和减少PF4的释放而发挥作用的。
Objective: To observe the clinical effect of tirofiban hydrochloride on acute myocardial infarction and its corresponding mechanism. Methods: The Fourth Affiliated Hospital of Harbin Medical University Emergency Center was selected for STEMI (n = 50). There were 35 males and 15 females with an average age of 58.4 ± 10.3 years and received medical treatment. Patients were randomized into the usual drug group (n = 23) and the tirofiban group (normotensive + tirofiban, n = 27). The changes of platelet aggregation rate at different time points (before treatment, during the administration, 2 hours after the end of administration) and the application of enzyme-linked immunosorbent assay (ELISA) were evaluated by observing the clinical symptoms and ST segment changes of electrocardiogram. The level of platelet factor 4 (PF4) in serum was measured by adsorbent assay (ELISA). And further correlation analysis. Results: Compared with the conventional drug group, chest pain in the tirofiban group was significantly reduced, the ST index of electrocardiogram was increased (P <0.05), and platelet aggregation rate was significantly decreased (P <0.001) during the course of drug delivery. Meanwhile, the level of PF4 (P <0.001), and was positively correlated with platelet aggregation (r = 0.86, P <0.001). CONCLUSION: Tirofiban Hydrochloride has definite therapeutic effect on acute ST-segment elevation acute myocardial infarction and may play its role by inhibiting platelet aggregation and reducing the release of PF4.