| Objective: Background: Myocardial infarction(MI)is a common and serious disease in Department of Cardiology.With the high mortality rate,with the change of people's life style,the incidence of myocardial infarction is increasing year by year.It is generally believed that the atherosclerotic plaque rupture,thrombosis blockage of blood vessels caused by myocardial ischemia and hypoxia.Antiplatelet therapy has been the core of myocardial infarction treatment.Aspirin,clopidogrel and tirofiban inhibit platelet function in different ways.Among them,the combined use of aspirin and clopidogrel is more thorough,which has been widely accepted.In theory,triple antiplatelet should be more beneficial.In fact,the combined use of tirofiban is not widely used in clinical practice,and a large part of which is due to adverse reactions,especially the increase in bleeding risk.This project intends to set the selected conditions,excluding hemorrhage in high risk population risk,and shorten the time to verify the use of triple antiplatelet,patients were eligible for this part of the short time of tirofiban combined with clopidogrel therapy can enhance antiplatelet,and no significant increase in adverse events,including bleeding.On the other hand,the rupture of the plaque and the necrosis of the myocardium accompanied with the inflammatory reaction,and the inflammatory reaction aggravated the process.The relationship between myocardial infarction and inflammatory factors has been reported at home and abroad.However,the screening of inflammatory factors has not been widely used in clinic,and has not been proved to be associated with prognosis.Whether the clinical efficacy of clopidogrel and tirofiban is associated with inflammation,and in particular,is associated with a variety of inflammatory markers.Methods : From April 2015 to December 2016 in department of cardiology ward of People's hospital of Deyang city with the diagnosis of myocardial infarction and 127 cases of patients with complete clinical data as the research object,patients are randomly divided into the observation group of68 cases and 59 cases in the control group.According to the condition of the patients after admission,Aspirin Enteric-coated Tablets,low molecular weight heparin sodium,angiotensin converting enzyme inhibitors,beta blockers,and other conventional treatment.The control group was given clopidogrel on the basis of routine treatment,the observation group was given tirofiban on the basis of the control group,all patients were treated for 2 weeks.Serum platelet activation parameters(CD62P,CD63,MPA)were measured by monoclonal antibody and flow cytometry.The levels of serum hs-CRP,IL-6,IL-10,IL-17 and TNF-were measured by enzyme linked immunosorbent assay.The serumlevels of D-D,Fig and coagulation parameters(TT,PT,APTT)were measured by automated coagulation analyzer and kit.The two groups of patients before and after treatment using cardiovascular angiography to determine the two groups before and after treatment of TIMI blood flow classification and monitoring the myocardial infarction area before and after treatment in the two groups by contrast-enhanced MRI.The changes of cardiac function indexes(LVEF,LVEDD,LVESD)before and after treatment in two groups were observed by ultrasonography.Before and after treatment,the patients were assessed with the Seattle angina scale(Seattle angina questionnaire,SAQ).The incidence of cardiovascular events and adverse reactions were observed and compared between the two groups.Results: 1.The total effective rate was 94.12% in the observation group than in the control group(n = 79.66%),and there was statistically significant difference(X2=5.99,P<0.05).2.Compared with before treatment,two groups of patients with serum hs-CRP,IL-6,IL-17,TNF-alpha,Fig were significantly decreased,while serum IL-10 and D-D levels were significantly higher,the difference was statistically significant(P<0.001);after treatment,the levels of serum hs-CRP,IL-6,IL-17,TNF-alpha and Fig level decreased significantly than the control group however,the serum levels of IL-10 and D-D increased significantly than the control group,and there was statistically significant difference(P<0.001).3.Compared with before treatment,the function of platelet activation indexeswere significantly decreased in two groups of patients CD62 P,CD63 and MPA and there was statistically significant difference(P<0.001);after treatment,observation group CD62 P,CD63,MPA,platelet activation function index levels were lower than control,and there was statistically significant difference(P<0.001).4.Compared with before treatment,two groups of patients with TT,PT,APTT and other blood coagulation indexes were significantly increased,the difference was statistically significant(P<0.001);after treatment,the observation group patients with TT,PT,APTT and other indicators of coagulation increased significantly compared with the control group,and there was statistically significant difference(P<0.001).5.The total improvement rate of TIMI in two groups was respectively 92.65%and 76.27%,the total improvement rate of the observation group was better than that of the control group,and there was statistically significant difference(P<0.01).6.Compared with before treatment,two groups of myocardial infarction area were significantly decreased,the difference was statistically significant(P<0.01);after treatment,the observation group of myocardial infarction area decreased significantly than the control group,and there was statistically significant difference(P<0.01).7.Compared with before treatment,two patients in group LVEF were significantly increased,LVEDD and LVESD were significantly decreased,thedifference was statistically significant(P<0.001);after treatment,patients in the observation group LVEF was significantly higher than the control group,LVEDD and LVESD decreased significantly than the control group,and there was statistically significant difference(P<0.001).8.Compared with before treatment,the dimensions of two groups of SAQ score were significantly increased,and there was statistically significant difference(P<0.001);after the treatment group in the level of physical activity limitation,angina stability,treatment satisfaction and disease cognition dimension scores were higher than the control group,and there was statistically significant difference(P<0.05 or P<0.001).9.The incidence of cardiovascular events during hospitalization in the two groups was 22.06% and 52.54%,respectively.The incidence of cardiovascular events in the observation group was lower than that in the control group,and there was statistically significant difference(P<0.01).10.The incidence of adverse reactions in the two groups of patients were14.70% and 40.67%,respectively,the incidence of adverse reactions in the observation group was lower than that in the control group,and there was statistically significant difference(P<0.01).Conclusion:1.Tirofiban combined with clopidogrel treatment can significantly improve the clinical symptoms of patients.2.Tirofiban combined with clopidogrel can enhance anti-inflammatory effect.3.Tirofiban combined with clopidogrel in short time can effectively improvethe quality of life of patients and there are no significant increase in the incidence of adverse reaction(including bleeding)during treatment,instead,the incidence is lower. |
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