不同剂量氯吡格雷对急性冠脉综合征患者的氯吡格雷抵抗及超敏C反应蛋白、P选择素水平的影响

Effects of different doses of clopidogrel on clopidogrel resistance and hs-CRP,P-selectin levels in patients with acute coronary syndrome

目的评价给予不同剂量氯吡格雷的急性冠脉综合征(ACS)患者氯吡格雷抵抗(CR)发生情况及对血小板聚集率和血清相关炎症因子水平的影响。方法选择ACS患者128例,随机分为两组,A组于确诊后即刻给予负荷量氯吡格雷300 mg,后服用维持量75 mg/d,B组于确诊后即刻给予负荷量600 mg,后服用维持量150 mg/d。分别于服药前和服药后3 d采用比浊法测定二磷酸腺苷(ADP)诱导的血小板聚集率;并于介入手术前、术后24 h和术后3 d分别抽取外周血,酶联免疫吸附法测定超敏C反应蛋白(hs-CRP)和P选择素水平。结果①B组的CR发生率低于A组(P<0.05)。②两组中发生CR者血小板抑制率均低于氯吡格雷反应正常者,而B组在氯吡格雷反应正常及发生CR的情况下血小板抑制率均高于A组(P<0.05)。③两组中发生CR者术后24 h及术后3 d血清hs-CRP和P选择素水平均高于药物反应正常者,而B组在药物反应正常及发生CR的情况下均较A组更有效降低血清hs-CRP、P-选择素水平(P<0.05)。结论对于ACS患者,相对于负荷量300 mg+维持量75 mg/d,给予负荷量600 mg+维持量150 mg/d的氯吡格雷可减少CR的发生率,并更有效地抑制血小板聚集及降低血清相关炎症因子水平。

Objective To evaluate the incidence of patients with acute coronary syndrome（ACS） in different doses of clopidogrel resistance（CR）,and to investigate the effects of clopidogrel on platelet aggregation and the level of serum inflammatory factors.Methods 128 ACS patients were randomly divided into two groups.Group A was treated with a loading dose of 300 mg clopidogrel followed by a maintenance dose of 75 mg / d,and group B was received a loading dose of 600 mg clopidogrel followed by a maintenance dose of 150 mg / d which assigned into group A and group B respectively.The turbidimetric method was used to detect the adenosine diphosphate（ADP） induced platelet aggregation rate before treatment and 3 days after treatment respectively.The levels of high sensitivity C-reactive protein（hs-CRP） and P-selectin were determined by enzyme-linked immunosorbent assay（ELISA）.Blood sampled were extracted before and 24 h and 3 days after pevcutaneous coronary intervention（PCI）.Results ① The occurrence rate of CR was lower in group B than that in group A（P〈0.05）.② The rate of platelet aggregation inhibition in CR was lower than that in normal drug response individuals of both groups.But the platelet aggregation inhibition rate in the occurrence of normal drug response and CR in group B was higher than that in group A（P〈0.05）.③ The levels of serum hs-CRP and P-selectin of CR were higher than normal drug response individuals at 24 h and 3 days after PCI in both groups.But compared with group A,the occurrence of normal drug response and CR,the levels of serum hs-CRP and P-selectin were significantly decreased in group B（P〈0.05）.Conclusion The incidence of CR and platelet aggregation and the level of serum inflammatory factors can reduce more effectively in the patients with ACS who are treated with dose of 600 mg clopidogrel followed by a maintenance dose of 150 mg / d than with 300 mg clopidogrel followed by a maintenance dose of 75 mg / d.