氯吡格雷抵抗患者抗血小板聚集药物疗效对比研究

Clinical efficacy and safety of different antiplatelet drugs in acute coronary syndrome patients with clopidogrel resistance

目的探讨氯吡格雷抵抗的急性冠脉综合征（acute coronary syndrome，ACS）患者应用不同抗血小板治疗方案（阿司匹林＋氯吡格雷＋西洛他唑、阿司匹林＋替格瑞洛）有效性和安全性的差异。方法选择2015年3月-2017年3月于中国石油天然气集团公司中心医院诊断为ACS并行冠脉介入的患者，经血栓弹力图检测二磷酸腺苷（adenosine diphosphate，ADP）途径血小板抑制率〈30％的氯吡格雷抵抗患者150例作为研究对象。随机分为2组，每组75人。观察组给予阿司匹林（100mg，每日1次）＋氯吡格雷（75mg，每日1次）＋西洛他唑（100mg，每日2次），对照组给予阿司匹林（100mg，每日1次）＋替格瑞洛（90mg，每日2次）。观察2组患者1周后ADP途径血小板抑制率的差异，半年内主要心脏不良事件及药物不良反应发生率的差异。结果两组患者在年龄、性别、合并疾病、合并用药、ADP抑制率等一般资料比较，差异均无统计学差异（P〉0．05）。治疗1周后，观察组ADP抑制率（46．69±11．13）％低于对照组（63．38±15．41）％，差异有统计学差异（P〈0．01）。随访6个月，两组患者主要心脏不良事件比较，差异无统计学差异（P〉0．05），而观察组药物不良反应（出血、呼吸困难）发生率更低。结论针对氯吡格雷抵抗的ACS患者两种抗血小板聚集治疗方案同样有效，而观察组安全性更好。

Objective To investigate the efficacy and safety of two different antiplatelet agents in patients with clopidogrel resistance in acute coronary syndromes （ACS）. Methods 150 ACS patients after percutaneous coronary intervention （PCI） in CNPC hospital with ADP （Adenosine diphosphate） inhibition rate less than 30% by thrombelastography from Mar.2015 to Mar.2017 were enrolled and randomly divided into two groups： 75 patients in observation group received aspirin （l00mg daily） and clopidogrel （75 mg daily） and cilostazol （100 mg twice daily）,and 75 patients in control group received aspirin （100 mg daily）and ticagrelor （90 mg twice daily）. A Week later the platelet ADP inhibition rate was evaluated in both groups again. The patients were followed up for half a year. The adverse events such as unstable angina peetoris, acute myocardial infarction, stent thrombosis and re-intervention or coronary artery bypass grafting, cardiac death, bleeding, dyspnea were observed. Results There was no significant difference between the two groups in age, sex, complication, drug combination and ADP inhibition rate （P 〉 0.05）. After one week of treatment the inhibitory rate of ADP of observation group was （46.69 ± 11.13）%, which was lower than that of the control group （63.38±15.41 ）% （P 〈 0.01）. There was no difference in major adverse Cardiac events between two groups （P 〉 0.05）, but drug adverse events of observation group was lower than control group. Conclusion Two treatments were effective in ACS patients with clopidogrel resistance, and observation group was more safe than control group.