经皮冠状动脉介入治疗后血小板高反应患者强化抗血小板治疗的效果

Clinical effects of enhanced anti-platelet therapy in patients with high platelet reactivity after percutaneous coronary intervention

目的探讨不同剂量氯吡格雷辅助治疗对行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者术后血小板高反应性(high platelet reactivity,HPR)的影响。方法选取西安市第五医院2012年1月至2012年12月行PCI治疗且确诊为HPR的患者共160例作为研究对象,采用随机数字表法分为对照组(80例)和强化组(80例),分别采用常规剂量氯吡格雷(75 mg/d)和高剂量氯吡格雷(150 mg/d)辅助阿司匹林治疗。比较两组患者术后HPR改善率、血小板聚集率、出血事件发生率、心血管意外事件发生率及不良反应发生率等。结果强化组患者术后HPR改善率显著高于对照组,差异有统计学意义[70.0%(56/80) vs.51.25%(41/80),P<0.05];强化组患者术后30 d血小板聚集率显著低于对照组,差异有统计学意义(54.33%±17.71% vs.48.15%±15.26%,P=0.012);两组患者术后出血事件发生率比较,差异无统计学意义(P>0.05);强化组患者术后1年心血管意外事件发生率显著低于对照组,差异有统计学意义(P<0.05);两组患者不良反应发生率比较,差异无统计学意义[5.00%(4/80) vs.7.50%(6/80),P=0.514]。结论高剂量氯吡格雷辅助治疗可有效改善行PCI治疗患者术后HPR,降低远期心血管意外发生风险,疗效优于常规剂量。

Objectives To investigate the influence of different doses of clopidogrel adjuvant treatment on high platelet reactivity （HPR） in patients after percutaneons coronary intervention （PCI）. Methods Totally 160 patients underwent PCI and diagnosed as HPR from January 2012 to December 2012 in The Fifth Hospital of Xi＇an City were chosen as research objects and randomly divided into control group （80 patients） with conventional doses of clopidogrel （75 mg/d） adjuvant with aspirin and enhanced group （80 patients） with high doses of clopidogrel （150 mg/d） adjuvant with aspirin. Improved rate of HPR, platelet aggregation rate, incidence of bleeding events, cardiovascular events and adverse reaction after PCI of both groups were compared. Results Improved rate of HPR in enhanced group was significantly higher than that in control group after PCI [70.0% （56/80） vs. 51.25% （41/80）, P〈0.05]. Platelet aggregation rate in enhanced group was significantly lower than that in control group 30 d after PCI （54.33%±17.71% vs. 48.15%±15.26%, P=0.012）. There was no significant difference in incidence of bleeding events after PCI between the two groups （P〉0.05）. Incidence of cardiovascular events in enhanced group was significantly lower than that in control group 1 year after PCI （P〈0.05）. There was no significant difference in incidence of adverse reaction 30 d after PCI between the two groups [5.00% （4/80） vs. 7.50% （6/80）,P=0.514]. Conclusions Compared with conventional doses of clopidogrel, high doses of clopidogrel adjuvant treatment in patients after PCI can effectively improve HPR and reduce the risk of cardiovascular events.