急性冠脉综合征患者氯吡格雷抵抗的影响因素

An investigation on the influencing factors of clopidogrel resistance in patients with acute coronary syndrome

目的评价急性冠状动脉综合征(ACS)患者氯吡格雷抵抗的发生情况及其可能的影响因素。方法所有入选患者均给予阿司匹林100mg/d,氯吡格雷负荷剂量300mg及维持量75mg/d,于服氯吡格雷前、服药后24h分别测定二磷酸腺苷(ADP,浓度25#mol/L)诱导的血小板聚集率,计算血小板聚集抑制率〔△A〕。△A≤10%(包括负值)时考虑存在氯吡格雷抵抗。结果102例ACS患者,其中△A≤10%(包括负值)者43例(42.2%),急性非ST段抬高心肌梗死及置入支架患者氯吡格雷抵抗的发生率高。结论ACS和冠状动脉介入治疗后的抗血栓治疗中,部分患者存在氯吡格雷抵抗。其发生与患者的疾病状态及是否置入支架明显相关。

Objective To evaluate the occurrence and the possible influencing factors of clopidogrel resistance in patients with acute coronary syndrome （ACS）. Methods All patients were treated with aspirin 100 mg/d and received a loading dose of 300 mg clopidogrel followed by a maintenance dose of 75 mg/d, Platelet aggregation induced by ADP with a concentration of 25 μmol/L was measured before and 24 hour after clopidogrel intake, and the inhibition of platelet aggregation （△A）was calculated, △A ≤ 10%（ including negative value） is considered as clopidogrel resistance. Results 102 patients with ACS were selected, there is 43 patients with the inhibition of platelet aggregation ≤ 10%, with the percentage of 42.2%. Conclusion A subgroup of patients with ACS and PCI aperas clopidogrel resistance in the antithrombotic therapy, the occurrence of clopidogrel resistance increases in the patients with acute non-ST segment elevation myocardial infarction and coronary stsnting.