国产氯吡格雷联合通心络对介入治疗术后不良事件的影响

Effect of combined domestic clopidogrel and tongxinluo on major adverse cardiovacular events after PCI

目的探讨进口氯吡格雷、国产氯吡格雷、国产氯吡格雷联合通心络的抗血小板效果及其对PCI术后主要不良心血管事件(MACE)的影响。方法连续选取2015年10月~2016年10月PCI患者220例,分为口服进口氯吡格雷(进口组)77例、口服国产氯吡格雷(国产组)80例,国产氯吡格雷合并通心络治疗(联合组)63例。观察3组PCI治疗及血小板高反应性(HPR)情况。对比3组MACE发生率。结果进口组、国产组、联合组3组间左前降支病变、球囊数量及HPR发生率比较,差异有统计学意义[63.6%vs 87.5%vs 77.8%,P=0.00;(2.3±1.1)个vs(2.8±1.4)个vs(2.7±1.5)个,P=0.026;24.7%vs 21.3%vs 11.1%,P=0.03]。进口组HPR发生率明显高于联合组(24.7%vs 11.1%,P=0.04)。3组MACE发生率比较,无统计学差异(P>0.05)。结论国产氯吡格雷与进口氯吡格雷的MACE发生率无显著差异,国产氯吡格雷联合通心络治疗介入术后患者,可能会降低药物抵抗现象,增加抗血小板疗效。

Objective To study the platelet inhibition rate of foreign clopidogrel,domestic clopidogrel,combined domestic clopidogrel and tongxinluo and their effct on major adverse cardiovacular events（MACE）after PCI.Methods Two hundred and twenty patients after PCI were divided into foreign clopidogrel treatment group（n=77）,domestic clopidogrel treatment group（n=80）,combined domestic clopidogrel and tongxinluo treatment group（n=63）.The high platelet reactivity（HPR）in 3 groups was detected by thrombelastography after PCI.The incidence of MACE in 3 groups was compared.Results The incidence of left anterior descending branch lesion was lower,the number of sacculi was smaller,and the incidence of HPR was higher in foreign clopidogrel treatment group than in domestic clopidogrel treatment group and combined domestic clopidogrel and tongxinluo treatment group after PCI（63.6% vs 87.5% vs 77.8%,P=0.002;2.3±1.1 vs 2.8±1.4 vs 2.7±1.5,P=0.026;24.7%vs 21.3%vs 11.1%,P=0.030）.The incidence of HPR was significantly higher in foreign clopidogrel treatment group than in combined domestic clopidogrel and tongxinluo treatment group（24.7% vs 11.1%,P=0.040）.No significant difference was found in the incidence of MACE in 3 groups（P〉0.05）.Conclusion The incidences of MACE of domestic clopidogrel and foreign clopidogrel are similar.Combined clopidogrel and tongxinluo can improve the platelet inhibition rate after PCI.