血栓弹力图测定老年急性冠脉综合征患者氯吡格雷抵抗的临床观察

Clinical Observation on Clopidogrel Resistance in Elderly Patients with Acute Coronary Syndrome Measured By Thromboelastograph

【目的】通过血栓弹力图（TEG）分析仪检测血小板聚集率，观察接受标准双联抗血小板治疗的住院老年急性冠脉综合征（ACS）患者的氯吡格雷抵抗发生率及可能的影响因素。【方法】选取109例老年（年龄≥60岁）ACS患者，在常规服用阿司匹林100mg／d基础上，口服氯吡格雷75mg／d，5d以后采血，通过TEG方法测定患者服用氯吡格雷和阿司匹林的血小板聚集率。以二磷酸腺苷诱导的血小板聚集率≥70％为氯吡格雷抵抗，花生四烯酸诱导的血小板聚集率〉50％为阿司匹林抵抗。【结果】氯吡格雷抵抗发生率为31．2％（34例），有10．1％（11例）发生阿司匹林和氯吡格雷双抵抗。氯吡格雷抵抗组与非抵抗组间阿司匹林抵抗的发生率有非常显著的统计学意义（P〈0．01）。两组患者在年龄、高血压、糖尿病、应用药物等方面差异无统计学意义（P〉0．05）；但氯吡格雷抵抗组中无吸烟史的患者更多，差异具有统计学意义（P=0．045）；此外还观察到女性（P=0．052）患者有容易发生氯吡格雷抵抗的趋势。【结论】接受标准抗血小板治疗的老年ACS患者中，31．2％存在氯吡格雷抵抗现象。这一现象不受年龄、合并疾病、服用药物等影响，而阿司匹林抵抗或从未吸烟的患者更易发生氯吡格雷抵抗。

[Objective] To measure the platelet aggregation by using thromboelastograph（TEG）, and to observe the incidence and possible influential factors of clopidogrel resistance in elderly hospitalized patients with acute coronary syndrome（ACS） receiving standard dual antiplatelet therapy. [Methods]A total of 109 elderly ACS patients were chosen. Based on the routine oral aspirin 100mg/d, all patients were given oral clopidogrel 75mg/d. At 5th day, blood sample was collected. TEG was used to measure platelet aggregation in patients taking clopidogrel and aspirin. Clopidogrel resistance was defined as adenosine diphosphate（ADP） induced aggregation≥70%, and aspirin resistance was defined as arachidonic acid（AA）-induced aggregation〉50%. [Results] The incidence of clopidogrel resistance was 31.2（34/109）, and the incidence of both clopidogrel and aspirin resistance was 10.1%（11/109）. There was significant difference in the incidence of aspirin resistance between clopidogrel resistance group and nonresistance group（ P 〈0.01）, while there was no significant difference in age, hypertension, diabetes mellitus and medicine between 2 groups（ P〉0.05）. In clopi- dogrel resistance group, most patients had no history of smoking, and there was significant difference（ P=0. 045）. Moreover, the results showed that female patients seems to be easy to have clopidogrel resistance（ P=0. 052）. [Conclusion] Clopidogrel resistant appears in 31.2 % in elderly patients with ACS receiving stand- ard dual antiplatelet therapy. Clopidogrel resistance is not influenced by age, concomitant disease and medicine, but patients with aspirin resistance or without smoking are easy to have clopidogrel resistance.