作者：白玉豪，李树仁，郝潇，罗飞，苑智慧，赵文静，李健超

单位：

1.063000河北省唐山市，华北理工大学研究生院 2.050051河北省石家庄市，河北省人民医院心血管内一科 3.050000河北省石家庄市，河北医科大学研究生院 4.075000河北省张家口市，河北北方学院研究生学院 通信作者：李树仁，E-mail：lsr64@126.com

单位（英文）：

1.College of Graduate School, North China University of Science and Technology, Tangshan 063000, China 2.Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, China 3.Graduate School of Hebei Medical University, Shijiazhuang 050000, China 4.College of Graduate School, Hebei North University, Zhangjiakou 075000, China Corresponding author: LI Shuren, E-mail: lsr64@126.com

关键词：

急性冠状动脉综合征; 带量采购政策; 抗血小板药物; 血小板聚集; 治疗结果;

关键词（英文）：

Acute coronary syndrome; Policy of quantity purchase; Antiplatelet drugs; Platelet aggregation; Treatment outcome

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.052

基金项目：

摘要：

背景急性冠脉综合征(ACS)具有发病急、治疗周期长、医疗负担重的特点,严重影响人类健康。带量采购政策的实施极大程度地减轻了ACS患者的医疗负担,提高了患者的依从性,但该政策实施时间较短,尚无针对抗血小板药物治疗ACS的疗效及安全性的头对头研究。目的 探讨带量采购政策实施前后抗血小板药物治疗ACS的疗效及安全性。方法 选取2018年12月至2021年4月就诊于河北省人民医院的ACS患者333例为研究对象。根据带量采购政策实施及本院实际情况,以服用药物时间(2020-01-01)为界,将患者分为带量采购政策实施前组(A组,108例)和带量采购政策实施后组(B组,225例)。收集患者临床资料,比较两组血小板聚集率、终点事件发生率。结果 A组BMI、有ACS家族史者所占比例高于B组(P<0.05)。A组花生四烯酸诱导的血小板聚集率低于B组(P<0.05)。A、B组中采用氯吡格雷治疗的患者分别有55、131例;A组中采用氯吡格雷治疗的患者的二磷酸腺苷(ADP)诱导的血小板聚集率低于B组(P<0.05)。A、B组中采用替格瑞洛治疗的患者分别有53、94例;A组与B组中采用替格瑞洛治疗的患者的ADP诱导的血小板聚集率比较,差异无统计学意义(P>0.05)。A组中采用氯吡格雷治疗的患者与采用替格瑞洛治疗的患者的ADP诱导的血小板聚率比较,差异无统计学意义(P>0.05);B组中采用氯吡格雷治疗的患者的ADP诱导的血小板聚率高于采用替格瑞洛治疗的患者(P<0.05)。A组与B组中采用氯吡格雷治疗的患者院内、随访6个月主要终点事件、次要终点事件发生率比较,差异无统计学意义(P>0.05)。A组与B组中采用替格瑞洛治疗的患者均未发生院内主要终点事件;A组与B组中采用替格瑞洛治疗的患者院内次要终点事件发生率及随访6个月主要终点事件、次要终点事件发生率比较,差异无统计学意义(P>0.05)。结论 带量采购政策实施后抗血小板药物治疗ACS的疗效及安全性不劣于带量采购政策实施前。

英文摘要：

【Abstract】　Background Acute coronary syndrome (ACS) has the characteristics of acute onset, long treatment periodand heavy medical burden, which seriously affects human health. The implementation of the policy of quantity purchase hasgreatly reduced the medical burden of ACS patients and improved their compliance. However, the policy has been implementedfor a short period of time, and there is no head-to-head study on the efficacy and safety of antiplatelet drugs in the treatmentof ACS. Objective To investigate the efficacy and safety of antiplatelet drugs in the treatment of ACS before and after theimplementation of the policy of quantity purchase. Methods A total of 333 ACS patients who were treated in Hebei GeneralHospital from December 2018 to April 2021 were selected as the research subjects. According to the implementation of the policyof quantity purchase and the actual situation of the hospital, taking the time of taking medicines (2020-01-01) as the boundary,the patients were divided into pre implementation of the policy of quantity purchase group (group A, 108 cases) and the postimplementation of the policy of quantity purchase group (group B, 225 cases) . The clinical data of the patients were collected, andthe platelet aggregation rate and the incidence of end-point events were compared between the two groups. Results BMI and theproportion of family history of ACS in group A were higher than those in group B (P < 0.05) . The platelet aggregation rate inducedby arachidonic acid in group A was lower than that in group B (P < 0.05) . There were 55 and 131 patients treated with clopidogrelin groups A and B, respectively; the adenosine diphosphate (ADP) -induced platelet aggregation rate of patients treated withclopidogrel in group A was lower than that in group B (P < 0.05) . There were 53 and 94 patients treated with ticagrelor in groups Aand B, respectively; there was no significant difference in the ADP-induced platelet aggregation rate between patients treated withticagrelor in group A and group B (P > 0.05) . In group A, there was no significant difference in ADP induced platelet aggregationbetween patients treated with clopidogrel and patients treated with ticagrelor (P > 0.05) ; in group B, the ADP induced plateletaggregation rate of patients treated with clopidogrel was higher than that of patients treated with ticagrelor (P < 0.05) . There wasno significant difference in the incidence of primary endpoint events and secondary endpoint events in hospital and 6-monthfollow-up between patients treated with clopidogrel in group A and group B (P > 0.05) . In group A and group B, there were noin-hospital primary endpoint events in patients treated with ticagrelor; there was no significant difference in the incidence of inhospital secondary endpoint events and the 6-month follow-up of primary endpoint events and secondary endpoint events betweenpatients treated with ticagrelor in group A and group B (P > 0.05) . Conclusion The efficacy and safety of antiplatelet drugs inthe treatment of ACS after the implementation of the policy of quantity purchase are not inferior to those before the implementationof the policy of quantity purchase.

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