老年患者抗血小板治疗状况调查

Investigation of anti-platelet therapy among senile patients

目的探讨老年患者基础疾病、服用抗血小板药物类型和剂量、影响抗血小板治疗效果的药物、血小板聚集功能检查结果及出血事件的发生情况,为老年患者的抗血小板治疗提供改进和指导。方法选择规律服用抗血小板药物并定期进行血小板聚集功能测定的老年患者1404例,归类分析基础疾病、服用抗血小板药物类型和剂量、同时联用可能影响抗血小板治疗效果的药物、血小板聚集功能检查结果及出血事件的发生情况。结果与未服用抗血小板药物患者比较,服用阿司匹林或氯吡格雷以及两药联用的患者,血小板聚集功能水平明显下降(P<0.01);服用氯吡格雷同时联用质子泵抑制剂(PPI)和(或)他汀类药物的患者,二磷酸腺苷诱导血小板聚集功能水平下降幅度均低于仅服用氯吡格雷的患者(P<0.01);服用氯吡格雷同时联用PPI和(或)他汀类药物的患者,以及服用氯吡格雷+阿司匹林+PPI和(或)他汀类药物的患者,二磷酸腺苷诱导血小板聚集功能水平下降幅度均低于仅服用氯吡格雷+阿司匹林的患者(P<0.01)。结论老年患者中仍存在一定比例的阿司匹林和氯吡格雷抵抗;同时服用PPI和(或)他汀类药物,对氯吡格雷的抗血小板治疗效果有潜在不利影响;合理的药物联用原则,高度个体化的抗血小板治疗方式,以及更加精确的血小板功能检测方法,需要尽快在临床推广应用。

Objective To investigate basic diseases, type and dosage of anti-platelet drugs,other drugs influencing the effects of anti-piateiet treatment, results of platelet aggregation function tests and incidences of hemorrhagic accidents, so as to provide improvement and guidance for the anti-platelet therapy among senile patients. Methods 1404 senile inpatients or outpatients were selected,who took anti-platelet drugs and were assayed for platelet aggregation function regularly;and the basic diseases, type and dosage of anti-platelet drugs, other drugs influencing the effects of anti-platelet treatment, results of platelet aggregation function tests and incidence of hemorrhagic accident were all analyzed. Results Compared with the patients without any anti- platelet treatment, the patients taking aspirin or clopidogrel or both displayed a statistically signif- icant descending of platelet aggregation function level（P〈0.01）;compared with the patients just taking clopidogrel,the patients taking clopidogrel with statin and（or） PPI showed lower descend- ing of platelet aggregation function level of ADP with statistically significant difference （P〈0. 01） ; compared with the patients taking only clopidogrel＋aspirin,the patients taking clopidogre with statin and（or） PPI, and the patients taking clopidogrel＋ aspirin with statin and（or） PPI, also showed lower descending on platelet aggregation function level of ADP with statistically signifi- cant difference（P%0.01）. Conclusions A certain ratio of resistance to aspirin and clopidogrel still exists in senile patients. Anti-platelet effect of clopidogrel was influenced potentially by statin and PPI. More reasonable combined pharmacotherapy,high individualized anti-platelet treatment and more accurate test on platelet aggregation function should be used clinically as soon as possible.