氯吡格雷血小板反应多样性研究进展

Variability of platelet response caused by clopidogrel

血小板反应多样性（VPR）是指不同个体对抗血小板药物的治疗反应存在的差异。氯吡格雷为临床常用抗血小板药物，其作用机制是不可逆地阻断血小板ADPP2Y12受体，抑制ADP与血小板受体的结合，并可抑制ADP介导的糖蛋白Ⅱb／Ⅲa复合物活化，从而抑制血小板聚集。氯吡格雷VPR的机制尚不清楚，可能是内外因素共同作用所致。外部因素主要包括患者种族、年龄、体重指数、依从性、肥胖、胰岛素抵抗、疾病状态及药物之间相互作用等；内部因素主要与氯吡格雷在体内的吸收和代谢及血小板受体的基因多态性有关。氯吡格雷VPR的检测方法主要以血管扩张剂刺激磷蛋白和ADP为靶点。总结氯吡格雷治疗的循证医学证据，建立血小板功能检测的金标准，对实施氯吡格雷个体化治疗及评估患者预后有重要意义。

Variability of platelet response （VPR） is the differences of different people in response to antiplatelet drugs. Clopidogrel are commonly used as clinical anti-platelet drugs, it irreversibly blocks the platelet ADP P2Y12 receptor, inhibits the binding of ADP and platelet receptor and inhibits activation of ADP-mediated glycoprotein Ⅱb/Ⅲa complex, thereby inhibits platelet aggregation. Clopidogrel VPR mechanism is unclear, it may be linked to a combination of internal factors and external factors, external factors include patient race, age, body mass index, compliance, obesity, insulin resistance, disease states and drug interaction; internal factors include the absorption and metabolism, and platelet receptor gene polymorphism. The detection methods of clopidogrel VPR are mainly as vasodilator-stimulated phospboprotein and adenosine diphosphate ADP as targets for testing. Summarizes evidence based medicine of elopidogrel and finding standard of platelet function testing method are important to implementing individualized treatment and evaluation of the prognosis.