冠心病经皮冠状动脉介入治疗术后氯吡格雷抵抗临床分析

Clinical analysis of clopidogrel resistance in patients with coronary heart disease after percutaneous coronary intervention

目的探讨与冠心病患者PCI术后氯吡格雷抵抗现象相关的危险因素。方法 108例冠心病患者(男性82例,女性26例,年龄29~90岁)行经皮冠状动脉介入治疗(PCI)。术前服用阿司匹林300mg、氯吡格雷300mg,术后服用阿司匹林100mg/d,氯吡格雷75 mg/d,术后第3天进行血栓弹力图凝血分析仪检测,根据二磷酸腺苷(ADP)诱导血小板聚集抑制率<30%和>30%分为氯毗格雷抵抗组与氯吡格雷不抵抗组。分析比较组间吸烟史、高血压病史、糖尿病史、血脂、血小板计数、血糖、C反应蛋白。结果 42例患者存在氯吡格雷抵抗,两组患者吸烟史、糖尿病史、血小板计数差异均有统计学意义(X^2=5.210、7.848、2 251,P<0.05)。logistic回归分析结果显示氯吡格雷抵抗的独立危险因素为吸烟史(Or=4.707,95%CI=1.796~12.316,P<0.01)、糖尿病史(OR=3.625,95%CI=1.363~9.641,P<0.05)、血小板计数(OR=0.990,95%CI=0.983~0.997,P<0.01)。结论 PCI术后的冠心病患者氯吡格雷抵抗发生率较高,糖尿病史、无吸烟史、血小板计数较高者易发生氯吡格雷抵抗现象。

Objective To explore associated risk factors of clopidogrel resistance in patients with coronary artery disease（CAD） after percutaneous coronary intervention（PCI）. Methods 108 CAD patients underwent PCI. They were treated with oral aspirin 300 mg and clopidogrel 300 mg before and aspirin 100 mg and clopidogrel 75 mg daily after PCI. Thrombelastography was performed at the third day post PCI. The patients were divided into clopidogrel resistance group and non- clopidogrel resistance group based on adenosine diphosphate （ADP） induced platelet aggregation inhibition 〈 or 〉 30%. The histories of diabetes, hypertension and smoking, serum lipid, platelet count, fast blood sugar and C- reaction protein were analyzed and compared between groups. Results Clopidogrel resistance occurred in 42 cases. There was significant difference of the history of smoking and diabetes,and platelet counts between the two groups （al P〈0.05）. Logistic regression analysis showed that no- smoking history（OR=4.707, 95%CI=1.796-12.316, P〈0.01）, history of diabetes （OR=3.625, 95%CI=1.363-9.641, P〈0.05）, and high platelet counts（OR=0.990, 95%CI=0.983-0.997, P〈0.01） were independent risk factors of clopidogrel resistance. Conclusion The incidence of clopidogrel resistance is higher in CAD patients after PCI. No- smoking history, diabetes and high platelet counts are risk factors of clopidogrel resistance.