经皮冠状动脉介入术后氯吡格雷抵抗的临床观察

Clinical observation of clopidogrel-resistance in patients undergoing percutaneous coronary intervention with clopidogrel

目的观察因急性冠脉综合征(ACS)行冠状动脉介入治疗(PCI)患者应用氯吡格雷后血小板聚集率的变化及氯吡格雷抵抗的发生情况。方法ACS患者37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2、4、6、24、48h以及服药后30d取血,测定ADP诱导的血小板聚集率,观察血小板聚集率变化并根据抑制程度判断氯吡格雷抵抗发生率。结果给药后2、4、6、24、48h及30d时,氯吡格雷抵抗的发生率分别为62%、46%、32%、38%、49%和43%,氯吡格雷抵抗者用药后血小板抑制率明显低于反应者,其中1例抵抗者出现亚急性支架内血栓形成。结论PCI治疗的部分患者中存在氯吡格雷抵抗。

AIM To examine the platelet aggregation and the prevalence of clopidogrel-resistance among patients undergoing percutaneous coronary intervention （PCI）. METHODS Thirty-seven patients with acute coronary symptom （ACS） who underwent PCI were treated with clopidogrel （300 mg, loading dose, followed with 75 mg/d）. Platelet aggregation function was assessed before and 2, 4, 6, 24, 48 h and 30 d after clopidogrel treatment. RESULTS The ratio of clopidogrel resistance were 62%, 46% , 32%, 38%, 49% and 43% at different times, platelet inhibition was much lower in clopidogrel resistants than responders, and subacute in-stent thrombosis occurred in one patient with clopidogrel resistance. CONCLUSION Clopidogrel-resistance may occur in some patients undergoing pereutaneous coronary intervention.