高龄急性冠状动脉综合征患者应用阿托伐他汀与瑞舒伐他汀对氯吡格雷抗血小板活性的影响

Effects of atorvastatin and rosuvastatin on antiplatelet activity of clopidogrel in elderly patients with acute coronary syndrome

目的在高龄急性冠状动脉综合征患者中,比较阿托伐他汀与瑞舒伐他汀对氯吡格雷抗血小板活性的影响。方法选取2014年4月-2015年2月于解放军总医院心血管内科住院的102例高龄(年龄>70岁)急性冠状动脉综合征患者为研究对象,将其随机分为两组,一组服用阿托伐他汀(20 mg,1次/d,n=53),另一组服用瑞舒伐他汀(10 mg,1次/d,n=49),两组均服用阿司匹林(100 mg,1次/d)及氯吡格雷(75 mg,1次/d)双联抗血小板药物,观察用药1周后两组血栓弹力图结果、血小板聚集功能,并对其进行3个月随访,观察两组主要不良心脏事件(major adverse cardiac events,MACE)发生率及他汀类药物的不良反应发生率。结果阿托伐他汀组与瑞舒伐他汀组比较,血栓弹力图ADP抑制率(58.75%±25.87%vs60.88%±31.42%)、血小板聚集功能(31.86%±19.81%vs 24.87%±19.20%)、MACE发生率、不良反应发生率差异无统计学意义(P>0.05)。结论在超高龄急性冠状动脉综合征患者中,经药物代谢酶CYP3A4代谢的阿托伐他汀与不经其代谢的瑞舒伐他汀均对氯吡格雷抗血小板活性无明显影响。

Objective To compare the effects of atorvastatin and rosuvastatin on antiplatelet activity of clopidogrel in elderly patients with acute coronary syndrome（ACS）. Methods From April 2014 to February 2015, 102 hospitalized elderly patients with acute coronary syndrome were assessed, the patients were randomly divided into atorvastatin 20 mg/d treatment group（n=53） and rosuvastatin 10 mg/d treatment group（n=49）. They all received anti-platelet treatment including aspirin（100 mg/d） and clopidogrel（75 mg/d） for one week, platelet aggregation and thrombelastogram were measured. All patients were followed up for 3 months, and major adverse cardiac events（MACE） rate and adverse drug reaction between the two groups were compared. Results There were no statistical differences in platelet inhibition ratio induced by ADP（58.75±25.87 vs 60.88±31.42）%, platelet aggregation function（31.86±19.81 vs24.87±19.20）%, MACE rate and adverse drug reaction between two groups（P〉0.05）. Conclusion Neither atorvastatin nor rosuvastatin attenuates the anti-platelet effects of clopidogrel during co-medication for elderly patients with acute coronary syndrome.