平均血小板聚集率水平对药物支架置入术后长期双联抗血小板治疗冠心病患者预后的影响

Relationship between the mean platelet aggregation degree and the prognosis of patients underwent long-term dual antiplatelet therapy following drug eluting stent implantation

目的 探讨在药物洗脱支架置入术后长期（超过12个月）双联抗血小板治疗的冠心病患者中,氯吡格雷药效对其预后的影响.方法 回顾性分析2006年9月至2009年6月在北京安贞医院置入药物洗脱支架的752例冠心病患者,在整个双联抗血小板治疗期间通过多次测定二磷酸腺苷（ADP）介导的血小板聚集率检测氯吡格雷对血小板的抑制程度,计算患者血小板聚集率的平均水平.根据血小板聚集率的平均水平分为低ADP水平组（374例）和高ADP水平组（378例）,随访时间为32.2（25.1,34.8）个月,比较2组患者的复合终点（包括全因死亡、非致死性心肌梗死、支架血栓、再次血运重建和卒中）发生率的差异.结果 与高ADP水平组患者相比,低ADP水平组患者多为男性,年龄较轻,且吸烟构成比较大（P均＜0.05）.单因素COX分析显示低ADP水平是复合终点的保护因素（HR =0.463,95％ CI 0.23 ～0.92,P=0.028）,多因素COX分析显示该相关性独立于其他危险因素（HR =0.495,95％ CI 0.25 ～0.99,P=0.046）.Kaplan-Meier曲线示高ADP水平组复合终点发生率高于低ADP水平组（log-rank x2=5.042,P=0.025）.结论 长期双联抗血小板治疗冠心病患者的预后与二磷酸腺苷介导的平均血小板聚集率水平有一定的相关性.

Objective To evaluate the association between the mean platelet aggregation degreeand the prognosis of patients underwent long-term dual antiplatelet therapy （DAPT more than 12 months） following drug eluting stent （DES） implantation.Methods A total of 752 patients were retrospectively analyzed who were received DES between September 2006 and June 2009.Adenosine diphosphate-induced platelet aggregation （ADP） was monitored during the course of treatment with DAPT,and the mean platelet aggregation degree of each participant was calculated.Based on the mean platelet aggregation degree,patients were divided into the low ADP degree group （374 cases） and the high ADP degree group （378 cases）.The median follow-up period was 32.2 （25.1,34.8） months.The comparison of the composite endpoints （all-cause death,nonfatal myocardial infarction,stent thrombosis,repeat revascularization and stroke） was performed between the two groups.Results Compared with the high ADP degree group,there were more male,younger and smoker patients in the low ADP degree group （all P 〈 0.05）.COX regression analysis showed that the low ADP degree group was associated with a decreased incidence of primary endpoints （HR =0.463,95% CI 0.23-0.92,P =0.028）.After adjustment with multivariable COX regression analysis,the relationship was proven to be independent of other risk factors （HR =0.495,95% CI 0.25-0.99,P =0.046）.The Kaplan-Meier curve demonstrated the incidence of the composite endpoints was significantly higher in high ADP degree group compared to that of low ADP degree group （log-rank x2 =5.042,P =0.025）.Conclusion The mean adenosine diphosphate-induced platelet aggregation degree is associated with the prognosis of patients underwent long term DAPT after DES implantation.