氯吡格雷抵抗患者的预测评分方法的探索

An exploration of predictive scoring method for patients with clopidogrel resistance

目的探讨本地区氯吡格雷抵抗患者的预测评分方法。方法用RCT法选取2013年5月-2014年4月在本院心病科就诊的冠心病患者365例,检测血小板数量、血小板聚集率及CD62p。入选患者服用氯吡格雷300 mg,75 mg/d维持7 d检测血小板数量、血小板聚集率及CD62p。根据患病史、检测数据与患者服用氯吡格雷前后血小板聚集率的情况,用Logistic回归法分析,最终得出氯吡格雷抵抗的预测评分表。结果服用氯吡格雷前后,血小板聚集率和CD62p差异有统计学意义(t值分别为14.12、4.50,P=0.00)。高血脂、糖尿病、CD62p与氯吡格雷抵抗的关系较大,高血压相对较小。结论急性冠心病患者有糖尿病、高血脂病史或者CD62p活性高,则氯吡格雷抵抗的发生几率较大;积分越高,氯吡格雷抵抗的发生几率就越大。

Objective Exploring the predictive scoring method of patients with clopidogrel resistance in the region. Methods Select 365 patients with acute coronary syndrome in accordance with randomized controlled trial（RCT） in cardiology department of our hospital from May 2013 to April 2014, then detect the platelet counts, platelet aggregation rate and CD62p. The selected patients took clopidogrel 300 mg, 75 mg/d for 7 days, again then detected the platelet counts, platelet aggregation rate and CD62p. The rate of platelet aggregation was measured according to the history of the disease, the test data and the platelet aggregation rate before and after taking clopidogrel, and using Logistic regression analysis, the prediction score table of clopidogrel resistance was finally obtained. Results Before and after taking clopidogrel, the difference of platelet aggregation rate and CD62p was statistically significant （ t values were 14.12, 4.50, P = 0.00）. The relationship between high blood lipids, diabetes, CD62p and clopidogrel resistance was large, hypertension was relatively small. Conclusion Acute coronary heart disease patients with diabetes, high blood lipid history or CD62p activity have a greater chance of clopidogrd resistance. The higher the score, the greater the probability of occurrence of clopidogrel resistance.