不同剂量氯吡格雷对急性冠脉综合征并肾功不全患者血小板聚集率的影响

Effect of different doses clopidogrel on platelet aggregation rate in aged patients with acute coronary syndrome and chronic kidney dysfunction

目的:比较不同剂量氯吡格雷对急性冠脉综合征(ACS)合并肾功能不全老年患者血小板聚集率的影响。方法:81例ACS并肾功能不全老年患者被随机分成两组,两组均予阿司匹林肠溶片300 mg顿服后,甲组(41例)予氯吡格雷75 mg/d维持,乙组(40例)予氯吡格雷50 mg/d维持。入院后24 h内和第28 d分别测定血小板聚集率(PAR),肝、肾功能并统计两组主要不良心血管事件和出血发生率。结果:(1)两组年龄,性别,血小板聚集率,肝、肾功能的基础状态无显著差异(P>0.05);(2)甲组第28 d血小板聚集率[以0.5μmol/L、1μmol/L二磷酸腺苷为诱导剂,分别为(24±15)%、(40±16)%],与基础状态(53±10)%、(75±11)%比较明显下降(P<0.05);乙组第28d血小板聚集率(24±14)%、(41±15)%与基础状态(52±10)%、(74±12)%相比也显著下降(P<0.05);但两组血小板聚集率治疗后无显著差异(P>0.05)。两组患者在28d内共发生心血管不良事件9例,甲组4例(9.8%),乙组5例(12.5%),两组无显著差异(P>0.05);(3)轻度出血,甲组5例(12.2%),乙组1例(2.5%),甲组明显增加(P<0.05);中重度出血甲组1例,乙组0例,两组无显著差异(P>0.05)。结论:急性冠脉综合征合并肾功能不全老年患者,服用不同剂量氯吡格雷均安全有效,低剂量(50 mg/d)可减少轻度出血并发症。

Objective： To investigate the effects of different doses clopidogrel on platelet aggregation rate （PAR） in aged patients with acute coronary syndromes （ACS） and chronic kidney dysfunction. Methods： The 81 aged ACS patients with chronic kidney dysfunction were randomizedly divided into two groups.. Group A （41 cases, treated with 75mg clopidogrel daily） ; Group B （40 cases, treated with 50mg clopidogrel daily）. PAR were measured on the baseline and after treatment, and the cardiovascular events within 28 days were recorded. Results： （1） After treatment the PAR significantly decreased [from （75±11）% to （40±16） %, （74±12）% to （40±15）% respectively, P〈0.05 all） in group A, B respectively, but there were no difference in two groups （P〉0.05） ; （2） The cardiovascular events were no difference between two groups after treatment （9.8%：12.5%, P〉0. 05）; （3） The mild bleeding event of group A （12.2%） was more than that of group B （2.5%） within 28 days （P〈0. 05）. Conclusion： Clinical effect of clopidogrel with different doses is same in the aged ACS patients with chronic kidney dysfunction, but the mild bleeding rate is more in patients with 75mg clopidogrel daily.