冠状动脉介入治疗术后氯吡格雷抵抗的生化指标分析

Analysis of Biochemical Markers Associated with Clopidogrel Resistance after Percutaneous Coronary Interventions

目的研究冠心病患者经皮冠状动脉介入治疗术(PCI)后氯吡格雷抵抗(CPGR)的发生率及其相关影响因素。方法 1入选符合研究要求PCI术后患者86例,于服药前、服药24 h后分别采血,采用光透射比浊法测定血浆二磷酸腺苷(ADP)诱导的血小板聚集率(PA),血小板聚集抑制率(△P)≤10%(包含负值)即为CPGR;2根据PA将研究组分为CPGR组和非CPGR组,观察CPGR与患者的相关临床生化指标的关系。结果 86例患者CPGR的发生率为38.4%(33/86)。两组患者空腹血糖值、糖化血红蛋白、血小板平均体积(MPV)、脂蛋白a的差异有统计学意义(P<0.05)。Logistic回归分析结果显示,氯吡格雷的独立危险因素有高空腹血糖、高糖化血红蛋白、高血小板平均体积。结论 1PCI术后服用氯吡格雷药物,确实存在CPGR现象,而测定PA有助于发现此类患者;2高空腹血糖、高糖化血红蛋白与高血小板平均体积可能是冠心病患者发生CPGR现象的危险因素。

Objective To observe the incidence and the influential factors of clopidogrel resistance （CPGR） in patients who received percutancous coronary interventions（PCI）. Methods Eighty six patients with PCI were subjected to the study. Light transmittance aggregometry was used to measure platclet aggregation （PA） induced by adenosine diphosphate （ADP） before and 5-7 days after clopidogrel intake. The AP measurements were based on the standard of AP ≤ 10% CPGR （negative values included） . The patients were divided into CPGR group and none CPGR group according to the △P. The relation between CPGR and the patients＇ relevant clinical biochemical indexes was observed. Results Among the 86 patients, the incidence rate of CPGR was 38.4% （33/86）. Significant differences were noted of fasting plasma glucose, glycosylated hemoglobin and MPV between the two groups （P〈0.05）. Logistic regression analysis revealed that fasting plasma glucose, glycosylated hemoglobin and PDW were independent risk factors of clopidogrel resistance. Conclusion Patients with percutaneous coronary interventions may have CPGR following clopidogrel treatment, which may be diagnosed by PA detection. Fasting plasma glucose, glycosylated hemoglobin and PDW are risk factors of clopidogrel resistance in patients with coronary heart disease.