急诊经皮冠脉介入治疗后急性心肌梗死患者氯吡格雷抵抗的发生率及影响因素

Prevalence and Risk Factors of Clopidogrel Resistance in Patients of Acute Myocardial Infarction Underwent Emergency Percutaneous Coronary Intervention

目的 评价急诊经皮冠脉介入治疗（PCI）的急性心肌梗死患者氯吡格雷抵抗的发生率及影响因素。方法 采用回顾性病例对照研究,选取2013年10月至2014年9月中国医科大学附属第一医院行急诊介入治疗的急性心肌梗死210例患者,根据血小板聚集率（PAR）将患者分为正常组和抵抗组,计算氯吡格雷抵抗的发生率,并分析年龄、性别、吸烟、饮酒、血压、血脂、糖化血红蛋白等指标与氯吡格雷抵抗的相关性。结果 急诊PCI术后氯吡格雷抵抗的发生率为36.67%。抵抗组和正常组的血小板聚集率分别为（62.62±9.23）%和（32.71±11.77）%,2组比较差异有统计学意义（P〈0.001）。多因素Logistic回归分析结果提示高的糖化血红蛋白水平与氯吡格雷抵抗呈正相关（P=0.037,OR 1.241,95%CI 1.013~1.519）。结论 高的糖化血红蛋白水平是氯吡格雷抵抗的独立危险因素,糖尿病患者如不注意血糖控制,将明显增加氯吡格雷抵抗的风险。

Objective To assess the prevalence and risk factors associated with clopidogrel resistance in patients with acute myocardial infarction after primary PCI （ percutaneous coronary intervention ）. Methods Using a retrospective case-control study, 210 patients with acute myocardiial in- faretion who underwent primary PCI in the first hospital affiliated to China Medical University between October 2013 and September 2014 were re- viewed. Patients were divided into the normal group and the resistance group according to the platelet aggregation rate （PAR）, and the incidence of clopidogrel resistance was calculated and the correlation between age, gender, smoking, alcohol drinking, blood pressure, blood lipid, glycosylated hemoglobin, and the clopidogrel resistance were analyzed. Results The incidence of clopidogrel resistance in patients underwent primary PCI was 36.67%. Platelet aggregation rates were 62.62±9.23% and 32.71 ± 11.77% respectively in two groups （P 〈 0.001 ）. Multivariate logistic regression analysis found that clopidogrel resistance was positively correlated to high level of glycosylated hemoglobin （P =0.037, OR 1.241,95%CI 1.013- 1.519）. Conclusion High level of glycosylated hemoglobin was the independent risk factor of clopidogrel resistance. The risk of clopidogrel resis- tance will significantly increase in these diabetic patients who cannot control blood sugar well