经皮冠状动脉介入术患者的氯吡格雷抵抗和心血管事件

Clopidogrel-resistant and cardiovascular event in patients undergoing percutaneous coronary intervention

目的:观察因急性冠脉综合征(ACS)行冠状动脉介入治疗(PCI)出现氯吡格雷抵抗及心血管事件的发生情况。方法:因ACS入院患者42例,予氯吡格雷负荷量300mg,继予75mg/d维持,在服用氯吡格雷前,服药后2h、4h、6h、24h、48h和服药后30d取血,测定ADP诱导的血小板聚集率,根据其抑制程度判断是否为氯吡格雷抵抗,观察氯吡格雷抵抗者心血管事件的发生情况。结果:给药后2h、4h、6h、24h、48h和30d时,氯吡格雷抵抗的发生率分别为59.5%、52.4%、38.1%、38.1%、47.6%和41.5%,16例24h时存在氯吡格雷抵抗者有3例出现心血管事件,虽未达统计学差异,但发生率明显高于无抵抗组。结论:PCI治疗的部分患者中存在氯格雷抵抗,并可能与心血管事件发生有关。

Objective： To observe clopidogrel-resistant and cardiovascular event among patients undergoing percutaneous coronary intervention （PCI）. Methods： The 42 patients with acute coronary symptom （ACS） who underwent PCI were treated with clopidogrel （loading dose 300mg, followed with 75mg/d）, 5μmol/L ADP-induced platelet aggregation was assessed before and 2h, 4h, 6h, 24h, 48h and 30d after clopidogrel treatment, observing the cardiovascular event among clopidogrel-resistant patients according to the inhibition of platelet aggregation. Results： The ratio of clopidogrel resistance was 59.5%, 52.4%, 38. 1%, 38. 1%, 47.6% and 41.5% at above-mentioned different times, cardiovascular events occurred in 3 patients among 16 patients with clopidogrel-resistance on 24h. Although there was no statistical difference among with and without clopidogrel-resistance two group, the ratio of clopidogrel resistance was much higher in clopidogrel-resistance patients than that of no clopidogrel-resistant patients. Conclusion： Clopidogrel-resistant may occur in some patients undergoing percutaneous coronary intervention and may relate with cardiovascular event after PCI.