不同剂量氯吡格雷对高龄冠心病合并慢性肾病患者影响的研究

Effect of different clopidogrel dosages in elderly coronary heart disease patients with chronic kidney disease

目的探讨高龄不稳定性心绞痛合并慢性肾病患者应用不同剂量氯吡格雷的有效性及安全性。方法选取2014年2月-2015年1月于解放军总医院心内科住院的216例高龄患者,随机分为A组95例（50mg/d氯吡格雷）,B组121例（75mg/d氯吡格雷）。记录全球急性冠状动脉事件注册危险评分、细胞色素P2C19基因型,以及应用氯吡格雷后血栓弹力图中二磷酸腺苷（ADP）抑制率,血小板抑制率等指标。随访6个月,观察2组心血管不良事件及不良反应发生情况。结果A组与B组服药6个月血栓弹力图中ADP抑制率[（67.85±13.23）%vs（69.42±14.78）%]和血小板抑制率[（33.36±12.78）%vs（26.96±12.26）%]比较,差异无统计学意义（P〉0.05）。A组与B组心血管不良事件发生率（7.37%vs 4.96%）及不良反应发生率（3.16%vs 4.13%）比较,差异无统计学意义（P〉0.05）。结论高龄不稳定性心绞痛合并慢性肾病患者低剂量氯吡格雷与常规剂量氯吡格雷发挥抗血小板活性的作用及安全性无明显差异。

Objective To study the effect and safety of different clopidogrel dosages in elderly unstable angina pectoris patients with chronic kidney disease.Methods Two hundred and sixteen elderly unstable angina pectoris patients with chronic kidney disease admitted to our hospital from February 2014 to January 2015 were divided into group A（n=95）and group B（n=121）.The patients in group A were treated with clopidogrel（50mg/d）and those in group B were treated with clopidogrel（75 mg/d）.Their GRACE risk score,CYP2C19 genotype,ADP inhibition rate and platelet aggregation function were recorded after clopidogrel treatment.The patients were followed up for 6months,during which the incidence of myocardial adverse events and adverse drug reaction was observed in two groups.Results No significant difference was found in ADP inhibition rate,platelet aggregation function,incidence of myocardial adverse events and adverse drug reaction between the two groups（67.85%±13.23%vs 69.42%±14.78%,33.36%±12.78%vs26.96%±12.26%,7.37%vs 4.96%,3.16% vs 4.13%,P〉0.05）.Conclusion The antiplatelet activity and safety of low and conventional clopidogrel dosage are similar in elderly unstable angina pectoris patients with chronic kidney disease.