冠状动脉介入术后氯吡格雷抵抗及影响因素

Clopidogrel resistance after percutaneous coronary intervention and its risk factor

目的:探讨冠心病患者行冠状动脉介入治疗术后氯吡格雷抵抗的发生率和影响因素。方法:冠心病患者317例,均经标准双联抗血小板药物治疗后行经皮冠状动脉介入治疗。以6μmol/L二磷酸腺苷作为诱导剂,根据比浊法测定术后第1天血小板聚集率的结果将317例患者分为氯吡格雷抵抗组和氯吡格雷有反应组,分析2组临床指标的差异。结果:氯吡格雷抵抗发生率24.0%。氯吡格雷抵抗组和氯吡格雷有反应组血小板聚集率分别为(58.4±7.0)%和(34.3±9.5)%(P<0.001)。多因素Logistic回归分析结果提示陈旧性心肌梗死病史(P=0.032,优势比2.834,95%CI1.091～7.361)、合并2型糖尿病(P=0.016,优势比2.130,95%CI1.151～3.941)和血清尿酸水平(P=0.004,优势比1.005,95%CI1.002～1.009)与氯吡格雷抵抗呈正相关。结论:陈旧心肌梗死病史、合并2型糖尿病和血清尿酸水平是氯吡格雷抵抗的影响因素。

Objective To assess the incidence and risk factors of clopidogrel resistance after percutaneous coronary intervention. Methods A total of 317 cases of coronary heart disease were divided into clopidogrel resistance group（n=76） and control group（n=241） according to the results of platelet aggregation by turbidimetry induced by 6 μmol/L adenosine diphosphate. The clinical indexes were analyzed and compared between the two groups. Results The incidence of clopidogrel resistance was 24.0%. Platelet aggregation rates were （58.4±7.0）% and （34.3±9.5）% respectively in two groups（P〈0.01）. Multivariate logistic regression analysis found that clopidogrel resistance was positively correlated to remote myocardial infarction （P=0. 032, OR 2. 834, 95% CI 1. 091 to 7. 361）, diabetes mellitus（P=0. 016, OR 2. 130, 95 % CI 1. 151 to 3. 941） and the level of serum uric acid （P=0. 004, OR 1. 005, 95 % CI 1. 002 to 1. 009）. Conclusion The remote myocardial infarction, diabetes mellitus and the increased level of serum uric acid are the risk factors of clopidogrel resistance.