吸烟对急性心肌梗死男性患者氯吡格雷抑制血小板功能的影响

Impacts of smoking on clopidogrel-induced antiplatelet action in male patients with acute myocardial infarction(AMI)

目的评价吸烟对急性心肌梗死男性患者服用氯吡格雷后血小板聚集率的影响。方法选取因急性心肌梗死住院的男性患者并成功接受急诊冠状动脉内支架置入术82例,术前给予氯吡格雷300mg负荷量口服,术后75mg/d口服。比浊法检测术前、术后24hADP(浓度5μmol/L)诱导的血小板聚集率结果。结果吸烟组患者介入术后24h血小板聚集抑制率≤10%(ΔA24h)明显高于不吸烟组(55%和35%,P<0.01),但不同吸烟量之间ΔA24h≤10%的比例差异无统计学意义(吸烟量<10支:吸烟量≥10支为53%:55%,P>0.05)。多因素回归分析结果显示吸烟后氯吡格雷服用后ΔA24h≤10%比例增加与年龄、合并糖尿病、合并高血压、支架植入数及C反应蛋白水平无关。结论吸烟可以增加氯吡格雷抵抗发生率,但吸烟数量与氯吡格雷抵抗发生率无关。

Objective To evaluate the impacts of smoking on rate of platelet aggregation （PAG） in male patients with acute myocardial infarction （AMI） after use of clopidogrel. Methods Eighty-two male patients who had been admitted due to AMI and had received successful emergent coronary stenting in our hospital were recruited. Oral clopidogrel was given to the patients at a loading dose of 300rag before surgery, followed by a maintenance dose of 75 mg/ day after surgery. Turbidimetry was used to determine the PAG rates induced by 5 mmol/L adenosine diphosphate （ADP） before and at 24 hours after surgery. Results At 24 h after intervention, more smoking males experienced ≤ 10% platelet aggregation inhibition （AA24h） than did the non-smokers （55% vs 35%, P〈0.01）. However, the rate of AA24h ≤ 10% was not significantly different when stratified on amount of smoking （smoking quantity〈10 cigarettes/day vs ≥ 10 cigarettes/day： 53% vs 55%,P〉0.05）. Multiple regression analysis showed that the increased rate of AA24h ≤ 10% after use of clopldogrel was independent of age, co-existing diabetes or hypertension, stenting and CRP level. Conclusion Smoking may increase the rate of clopidogrel resistance （CLR） that appears independent of the amount of smoking.