不同负荷剂量氯吡格雷治疗急性冠脉综合征的临床应用研究

CLINICAL STUDY ON COMPARISON OF DIFFERENT LOADING-DOSE OF CLOPIDOGREL ON ACUTE CORONARY SYNDROME

目的比较不同负荷剂量氯吡格雷在经皮冠脉介入治疗(PCI)术前应用对治疗急性冠脉综合征(ACS)的有效性和安全性,对更高负荷剂量的氯吡格雷安全性进行评估。方法120例诊断为ACS的患者随机分为A、B、C三组(na=nb=nc=40),三组患者临床基本资料差异无统计学意义(p>0.05)。A、B、C三组分别于术前6h给予600mg、450mg和300mg负荷剂量氯吡格雷,观察服药前?服药后2h、4h、6h血小板聚集率,30天主要终点事件(住院期间休克、死亡、靶血管重建、再发心梗、心绞痛、脑卒中)及术后30天出血事件和不良反应发生情况。结果与标准的300mg方案相比,氯吡格雷600mg比氯吡格雷450mg前6h内对血小板激活的抑制程度更大。氯吡格雷负荷剂量的增加可减少30天主要心血管事件的发生率。三组30天出血事件和不良事件发生情况差异无统计学意义(p>0.05)。结论与300mg氯吡格雷负荷剂量相比,较高的氯吡格雷负荷剂量能够产生更快、更强的血小板抑制,且安全性相似。

Objective To compare the efficiency and safety of clopidogrel of different loading - dose in acute coronary syndromes（ACS） patients with pereutaneous coronary intervention（PCI） therapy, and, give an assessment of security about higher loading dose of clopidogrel. Methods 120 patients from January 2008 to January 2009 in our hospital were included. They were randomly divided into 3 groups （ na =nb = nc = 40） and were given 600 rag, 450 mg and 300 mg clopidogrel on the 6 hour before PCI. There was no significant difference between the three groups＇ basic clinical information（p 〉0. 05） ,such as age, sex and so on. Four points were selected to observe： the platelet aggrega- tion induced by ADP with 5umol/L before and two hours,four hours, six hours after taking medicine; Primary endpoint events, which include shock during hospitalization, death, target revascularization, myocardial infarction, recurrent an- gina, stroke in 30 days, and Postoperative Bleeding events and adverse Reactions after Surgery in 30 days. Results compared to the standard dose of 300 mg clopidogrel, 600 rag doses clopidogrel can give a greater degree of inhibition on platelet activating than 450 mg doses in the pre - 6 h after administration. Increase Clopidogrel loading dose can reduce the occurrence of major cardiovascular events rate. Bleeding events and the occurrence of adverse events was no signifi- cant difference among three groups. Conclusions compared to the standard dose of 300 mg clopidogrel, a higher load- iag dose of clopidogrel can produce much more faster, greater platelet inhibition, and similar security.