不稳定型心绞痛患者氯吡格雷抵抗的发生及影响因素

The occurrence and influencing factors of clopidogrel resistance in unstable angina pectoris patients

目的探讨不稳定型心绞痛患者氯吡格雷抵抗(CPR)的发生及其影响因素。方法 190例不稳定型心绞痛患者,服用75 mg和150 mg不同剂量氯吡格雷,检测血小板聚集率(PAR),比较服药前后及不同剂量的差异,判断有无CPR发生。收集患者基础特征资料,寻找CPR的独立预测因子。结果 75 mg组患者80例,150 mg组110例,2组共有22例出现CPR,发生率为11.6%(P>0.05)。氯吡格雷抵抗组中,75 mg与150 mg组治疗前后,PAR无明显变化(P>0.05)。非氯吡格雷抵抗组中,75 mg与150 mg组治疗前后,PAR有明显变化(P<0.05),且150 mg组降低更明显(P<0.05)。2型糖尿病、超敏C反应蛋白(HCRP)与CPR呈正相关性,Logistic回归显示2型糖尿病、HCRP升高为CPR的独立预测因子;总体预测概率ROC曲线下面积为0.762,诊断准确度达到中等水平。结论氯吡格雷抵抗现象客观存在,75 mg和150 mg剂量下均会发生,不因剂量的增加和服药时间的延长而明显变化;2型糖尿病、HCRP可作为CPR的独立预测因子,具有临床参考价值。

Objective To investigate the occurrence of clopidogrel resistance （CPR） and its influencing factors in unstable an- gina pectoris （UAP）. Methods 190 patients with unstabte angina peetoris were treated with 75 mg clopidogrel and 150 mg clopidogrel, the platelet aggregation rate （PAR） was measured and the difference of CPR before and after the treatment was evaluated. The basic characteristics of patients were collected and the independent predictors of CPR were searched. Results There were 80 cases in 75 mg group, 110 cases in 150 mg group, CPR occurred in 22 cases,the incidence rate was 11.6%. Chi square test showed（P 〉 0.05）. In the clopidogrel resistant group,there was no significant change in PAR between the 75rag and the 150mg group （P 〉 O. 05 ）. In the non - clopidogrel resistant group, there were obvious change in PAR before and after treatment in 75mg and 150mg group （P 〈 O. 05） and the decrease in 150rag group was more obvious （ P 〈 0.05 ）. Indexes of type 2 diabetes ,high sensitive C reactive protein were positively cor- related with CPR. Logistic regression analysis showed：type 2 diabetes, high sensitive C reactive protein （HCRP） increased as independent predictors of CPR,the overall probability forecast area under the ROC curve was O. 762, diagnostic accuracy reached the medium level. Conclusion clopidogrel resistance is an objective phenomenon,75 mg and 150 mg dose will happen and will not obviously change be- cause of the extension of the increased dosage and medication time. HCRP can be looked as an independent predictor of CPR in type 2 diabetes mellitus.