脑梗死二级预防中CYP3A4代谢与非CYP3A4代谢的他汀类药物对氯吡格雷抗血小板聚集功能的影响及降脂疗效的比较

Effect of Clopidogrel platelet-resisting and liquid reducing between CYP3A4-metabolized and non CYP3A4 metabolized statin in secondary prevention of cerebral infarction

目的观察脑梗死二级预防患者服用高强度的阿托伐他汀(40 mg/d)或瑞舒伐他汀(20 mg/d)对氯吡格雷(75 mg/d)抗血小板聚集功能的影响及降脂疗效。方法初选80例,最终入组并观察完成66例脑梗死二级预防患者,随机分为阿托伐他汀组和瑞舒伐他汀组各33例,所有患者随访3个月,分别于服用氯吡格雷前、服用氯吡格雷1 w后、加用他汀1 m后、3 m后测定血小板聚集功能,检测血脂、肌酶、肝酶等相关指标,观察3 m内的主要心脑血管等不良事件。结果服用氯吡格雷(75 mg/d)能明显降低血小板聚集率,两组患者在加用他汀1 m后、3 m后的血小板聚集率均未发生明显变化,且同期对比无差异。3 m随访期间,服用高强度的他汀后两组患者的CHOL、LDL-C较基线明显降低(P<0.05),但同期对比无差异(P>0.05);随访期间两组患者均未为发生心脑血管不良事件,但有个别患者出现肌酶或肝酶升高,两组对比无差异(P>0.05)。结论脑梗死二级预防患者服用高强度的阿托伐他汀或瑞舒伐他汀对氯吡格雷的抗血小板聚集功能未产生明显的影响,且降脂疗效相近。

Objective Evaluate the curative effect of anti-platelet aggregation by Clopidogrel（ 75 mg / d） in the patients of secondary prevention of cerebral infarction with a high dose of Atorvastatin（ 40 mg / d） or Rosuvastatin（ 20 mg/d）. Methods 80 cases were screened primarily and 66 of them were finally chosen in our study as patients of secondary prevention of cerebral infraction. 66 patients were divided into two groups equally in random and treated with Atorvastatin and Rosuvastatin respectively after treating Clopidogrel for one week. PAR,blood liquid,muscle and liver enzymes would be detected in four stages： pre-treating with Clopidogrel,one-month treating with Clopidogrel,one-month and threemonth treating with Clopidogrel and Atovastatin or Rosuvasratin and the MACCEs were evaluated after a three-month follow up. Results Platelet aggregation rate（ PAR） were detected after treatment of Clopidogrel（ 75 mg / d）,there was no statistically difference of PAR between the groups treated Atorvastatin and Rosuvastatin after a one or three-month treatment. In the period of the three-month follow-up. The the level of CHOL and LDL-C of the two groups with high dose of Atovastatin or Rosuvasratin decreased significantly than the baseline（ P〈0. 05）. However,there was no difference between this two groups（ P〉0. 05）. No MACCE was reported during the follow-up,some of the patients had a high level of muscle and liver enzymes,no difference between this two groups（ P〉0. 05）. Conclusion Treatment with a high dose of Atorvastatin or Rosuvastatin Clopidogrel would not impact on the effect of anti-platelet and in the patients of secondary prevention of cerebral infarction and lower the level of blood liquid significantly.