冠心病患者冠状动脉介入治疗术后氯吡格雷抵抗的发生率及影响因素

Incidence and influential factors of clopidogrel resistance in coronary heart disease patients who received percutaneous coronary interventions

目的探讨冠心病患者冠状动脉介入治疗术(percutaneous coronary interventions,PCI)后氯吡格雷抵抗发生率及其影响因素。方法选取新桥医院心内科2009年9月至2010年7月期间112例行PCI术治疗的冠心病患者,术前予氯吡格雷300 mg负荷剂量治疗,术后予75 mg/d持续治疗。测其服药前、术后24 h和术后5 d以5μmol/L的二磷酸腺酐(adenosine diphosphate,ADP)诱导的血小板最大聚集率(maximum platelet aggregation rate,MPAR)、CD62P和PAC-1等指标。以血小板聚集抑制率≤10%定义为氯吡格雷抵抗,分为氯吡格雷抵抗组和对氯吡格雷反应性正常组,比较2组临床基本资料、相关常规检查、MARP、CD62P、PAC-1指标及术后随访情况。结果抵抗组和正常组的临床基本资料、相关常规检查及PCI术基本特征等无明显差异;PCI术后24 h和术后5 d发生氯吡格雷抵抗患者分别为46例(41.07%)和27例(24.11%);服药前及PCI术后抵抗组CD62P、PAC-1均高于正常组(P<0.05);术后6个月随访抵抗组心血管事件发生率高于正常组。结论 PCI术前血小板的活化水平是发生氯吡格雷抵抗的独立影响因素之一。

Objective To discuss the incidence and influential factors of clopidogrel resistance in coronary heart disease patients who received percutaneous coronary interventions （PCI）. Methods One hundred and twelve coronary heart disease patients who underwent PCI in Xinqiao Hospital, Chongqing, China, from Sep. 2009 to Jul. 2010 were selected. Clopidogrel of 300 mg loading dose and 75 mg/d ongoing dose was administered before and after PCI. The 5 μmol/L adenosine diphosphate （ADP）-induced maximum platelet aggregation rate （MPAR）, CD62P, and PAC-1 were tested before administration as well as 24 h and 5 d after PCI. The patients were divided into a clopidogrel-resistant group （platelet aggregation rate ≤10% ） and a normal response group. The basic clinical data, related routine examination results, MARP, CD62P, PAC-1, and following-up information of the two groups were compared. Results The basic clinical data, related routine examination results, and PCI basic characteristics of the clopidogrel-resistant group and normal response group showed no obvious difference. Forty-six patients （41. 07% ） and twenty-seven patients （24. 11% ） suffered clopidogrel resistance 24 h and 5 d after PCI, respectively. CD62P and PAC-1 levels of the former group were higher than those of the latter one before administration and after PCI （ P 〈 0.05 ）. The six-month following-up showed that the cardiovascular event incidence of the former group was higher than that of the latter one （P 〈 0.01 ）. Conclusion The platelet activation level before PCI is an independent influential factor for clopidogrel resistance incidence.