经皮冠状动脉介入治疗术后出现氯吡格雷抵抗患者的治疗方案选择

Treatment options for the patients with clopidogrel resistance after percutaneous coronary intervention

目的 :探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后出现氯吡格雷抵抗患者换用双倍剂量氯吡格雷和替格瑞洛治疗的有效性及安全性。方法:选取PCI术后出现氯吡格雷抵抗(血小板抑制率<30%)患者188例,随机分为氯吡格雷常规剂量组(A组,64例)、氯吡格雷双倍剂量组(B组,61例)、替格瑞洛组(C组,63例),术后7 d分别检测二磷酸腺苷(adenonisine disphosphate,ADP)通道的血小板抑制率、术后1 d及7 d检测超敏C反应蛋白(high sensitivity C reactive protein,hs CRP),观察术后1个月及6个月时主要心脏不良事件(major adverse cardiovascular events,MACE)及轻度出血发生率。结果:术后7 d检测ADP通道的血小板抑制率,B组及C组血小板抑制率明显升高,和A组相比差异有统计学意义(P<0.05);且C组血小板抑制率高于B组(P<0.05)。术后1 d检测hs CRP,3组结果差异无统计学意义,术后7 d检测hs CRP,B组及C组均明显降低,和A组相比差异有统计学意义(P<0.05);相比B组,C组hs CRP降低更明显(P<0.05)。随访至术后1个月,3组之间MACE及轻度出血发生率无明显差异(P>0.05);随访至术后6个月时,B组及C组MACE发生率均显著低于A组,差异有统计学意义(P<0.05),且C组MACE发生率低于B组(P<0.05),但3组之间轻度出血发生率差异仍无统计学意义(P>0.05)。结论:PCI术后出现氯吡格雷抵抗患者,选用替格瑞洛治疗具有更好的有效性,且不增加不良反应。

Objective：To investigate the clinical effectiveness and safety of double dosage of clopidogrel and ticagrelor in patients with clopidogrel resistance after percutaneous coronary intervention（PCI）. Methods：A total of 188 patients with clopidogrel resistance（platelet inhibition rate 30%）after PCI were randomly divided into the conventional clopidogrel group（group A,n =64）,the double dosage of clopidogrel group（group B,n =61）and the ticagrelor group（group C,n =63）. The platelet inhibition rate of the adenosine diphosphate（ADP） pathway was tested at the seventh day after PCI,high sensitivity C reactive protein（hs CRP）was measured at the first and the seventh day after PCI,the incidence rates of major adverse cardiovascular events（MACE）and slight bleeding were compared among the three groups at the first month and the sixth month follow-up. Results：At the seventh day after PCI,the platelet inhibition rates in group B and C were significantly higher than that in group A（both P 〈0.05）,and the rate in group C was higher than that in group B（P 〈0.05）. At the first day after PCI,no significant difference in hs CRP was observed among the three groups（P 〉0.05）. However,at the seventh day after PCI,hs CRP in group B and C was significantly reduced compared with the group A,respectively（both P 〈0.05）,and hs CRP in group C was lower than that in group B（P 〈0.05）. At the first month follow-up,there were no significant differences in the incidence rates of MACE and the slight bleeding among the three groups（P 〉0.05）. At the sixth month follow-up,the incidence rates of MACE in group B and C were significantly reduced compared with group A（both P 〈0.05）,and the rate in group C was lower than that in group B（P 〈0.05）,but there was still no significant difference in the incidence rate of slight bleeding among the three groups（P 〉0.05）. Conclusion：In patients with clopidogrel resistance after PCI,ticagrelor is more effective without increasing adverse reactions.