新型P2Y12受体抑制剂对急性冠状动脉综合征介入治疗后患者血小板反应性的影响

Impact of novel P2Y12 receptor inhibitors on platelet reactivity in acute coronary syndrome patients undergoing percutaneous coronary intervention

目的 探讨不同P2Y12受体抑制剂对急性冠状动脉综合征（ACS）行经皮冠状动脉介入治疗（PCI）患者血小板反应性的影响,为国人使用新型P2Y12受体抑制剂提供数据.方法 前瞻性纳入201 1年10月至2014年2月澳门镜湖医院心脏科连续性收治符合入选条件的患者174例,其中男性135例,平均年龄（67.8±11.8）岁.PCI术后连续服用阿司匹林和1种P2Y12受体抑制剂,即双联抗血小板治疗（DAPT）,按P2Y12受体抑制剂不同分为氯吡格雷组、普拉格雷组和替格瑞洛组.采用VerifyNow P2Yu系统在DAPT≥5 d后检测血小板功能,根据P2Y12反应单位（PRU）区分为抗血小板治疗后高血小板反应性（HPR）（PRU≥208）和非HPR（PRU＜ 208）,对HPR患者调整DAPT方案≥5d后再次检测血小板功能.结果 氯吡格雷组113例（64.9％）,普拉格雷组20例（11.5％）,替格瑞洛组41例（23.6％）.P2Y12受体抑制剂治疗后呈HPR共57例（占32.8％）,主要为氯吡格雷,占55例（55/113,48.7％）.氯吡格雷组、普拉格雷组和替格瑞洛组对血小板反应性的抑制程度差异有统计学意义（P2Y12抑制率分别为28.2％±23.5％、61.4％±26.7％和81.3％ ± 19.8％,P＜0.05）;3组治疗不同时间段检测的血小板反应性不同,在治疗早期其差异已有统计学意义（P＜0.05）.氯吡格雷治疗后HPR者替换为普拉格雷或替格瑞洛治疗后,能更有效抑制血小板聚集（P＜0.05）.结论 新型口服P2Y12受体抑制剂能更有效抑制血小板聚集,为氯吡格雷治疗后HPR者、临床或PCI显示出高血栓风险的ACS患者的治疗提供了新选择.

Objective To investigate the impact of novel P2Y12 receptor inhibitors including prasugrel or ticagrelor on platelet reactivity in patients with acute coronary syndrome （ACS） receiving percutaneous coronary intervention （PCI）,and provide clinical data for novel oral P2Y12 receptor inhibitors use among Chinese patients.Methods Between October 2011 to February 2014,174 consecutive patients （135 males;（67.8 ± 11.8） years old） with ACS undergoing PCI in Kiang Wu Hospital,Macao were prospectively enrolled in this study.Oral aspirin and one P2Y12 receptor inhibitor were administered for 5 days or above after PCI,patients were divided into clopidogrel,prasugrel and ticagrelor groups in accordance with the agent administered.Platelet reactivity of the patients was detected by VerifyNow P2Y12 reaction unit （PRU）;and the high on-treatment platelet reactivity （HPR） and non-HPR were defined as PRU ≥208 and PRU 〈 208 respectively.Patients with HPR during clopidogrel therapy were switched either to prasugrel or ticagrelor,or continued the same treatment;and then the platelet reactivity was monitored again.Results There were 113 clopidogrel cases （64.9%）,20 prasugrel cases （11.5%） and 41 ticagrelor cases （23.6%）.Fifty-seven cases （32.8%） were defined as HPR post P2Y12 receptor inhibitor use,in which 55 cases （55/113,48.7%） were treated with clopidogreh The degree of inhibition of platelet reactivity was significantly different in patients on clopidogrel,prasugrel and ticagrelor therapy,percent inhibition assayed by the VerifyNow P2Y12 system was 28.2% ±23.5%,61.4% ±26.7% and 81.3% ± 19.8% respectively （P 〈 0.05）.Different degree of platelet reactivity was achieved by the 3 P2Y12 receptor inhibitors at multiple time points.The among-group differences in platelet reactivity became apparent at the early treatment stage （P 〈 O.05）.Platelet aggregation decreased significantly in patients switched from clopidogrel to prasugrel or ticagrelor （P 〈 0.05）.Conclusion Novel oral P2Y12 receptor inhibitors are more effective in inhibiting platelet reactivity in ACS patients,and our results show that novel oral P2Y12 receptor inhibitors provide a new option for ACS patients with HPR post clopidogrel or high-risk features of ischemic complications,including stent thrombosis and post-PCI ischemic events.