氯吡格雷抑制尿毒症患者血小板聚集的效果

Effect of clopidogrel inhibiting platelet aggregation in patients with uremia

目的研究尿毒症维持血液透析患者在服用氯吡格雷后能否达到有效的抗血小板作用,为尿毒症维持血液透析合并冠状动脉粥样硬化性心脏病(冠心病)患者抗血小板的规范化治疗提供理论依据。方法选取2014年1月至2015年12月在解放军161医院进行维持血液透析的尿毒症同时罹患冠心病的患者127例作为实验组,男71例,女56例,年龄(67±10)岁;同时选取肾脏功能正常并罹患冠心病的患者95例作为对照组,男64例,女31例,年龄(65±12)岁。两组均服用阿司匹林100 mg/d和氯吡格雷75 mg/d>4周。采用血栓弹力图检测外周血中血栓最大弹力度(maximum amplitude,MA)值和二磷酸腺苷(adenosine diphosphate,ADP)受体抑制率,以此判断药物抑制血小板聚集的作用。结果尿毒症维持血液透析组MA值较对照组偏高,且差异具有统计学意义[(62±6)mm vs.(53±5)mm,P<0.01];而尿毒症维持血液透析组ADP受体抑制率较对照组偏低,且差异具有统计学意义(51.4%±17.2%vs.60.1%±16.1%,P<0.01)。结论与单纯冠心病患者相比,尿毒症维持血液透析合并冠心病患者氯吡格雷对血小板抑制率降低,药物敏感性降低,可能无法达到期望中的抗血小板作用。

Objectives To discuss the effect of clopidogrel inhibiting platelet aggregation in patients with uremia ,and to provide theory basis of the standardization of antiplatelet therapy for patients with uremia and coronary heart disease （CHD）. Methods Totally 127 patients （71 men and 6 women） undergong maintenance hemodialysis complicated with uremia and CHD between January 2014 and December 2015 were selected as experimental group. As control ,we selected 95 patients with CHD and normal renal function. All these patients took aspirin（100 mg/d）and clopidogrel （75 mg/d）for more than 4 weeks. Maximal amplitude（MA）was measured in the original blood sample by thrombelas-tography （TEG） and adenosine diphosphate （ADP） receptor inhibition rate was calculated to evaluate the effect of drugs for inhibiting platelet aggregation. Results MA level in uremia group was significantly higher than that in control group[（62±6）mm vs.（53±5）mm,P〈0.01],and ADP receptor inhibition rate in uremia group was significantly low-er than that in control group（51.4%±17.2% vs. 60.1%±16.1%,P 〈0.01）. Conclusions Compared to the patients with CHD,platelet inhibition rate induced by clopidogrel is decreased in patients undergone maintenance hemodialysis complicated with uremia and CHD ,it indicates that the drug sensitivety decreases and antiplatelet effect could not reach the expectation value.