血府逐瘀胶囊对重度血瘀证患者经皮冠状动脉介入治疗术后氯吡格雷抵抗的调节作用

Regulating effect of Xuefuzhuyu capsule on clopidogrel resistance in patients with severe blood stasis syndrome after PCI operation

目的观察血府逐瘀胶囊联合氯吡格雷治疗氯吡格雷抵抗患者的效果,评价其改善氯吡格雷抵抗作用的效果。方法经皮冠状动脉介入治疗(PCI)术后氯吡格雷抵抗患者80人,随机分组,分别给予3种药物治疗方案:A组用国产氯吡格雷(泰嘉)加用血府逐瘀胶囊;B组使用进口氯吡格雷(波立维);C组用国产氯吡格雷(泰嘉)加用西洛他唑,连续3个月,采用血栓弹力图法检测干预后血小板抑制率。并随访患者半年,观察临床不良事件的发生率。结果治疗3个月后,各组抑制率均有所提高,且均有显著差异(P<0.05)。A组对血小板抑制的有效率达40%,优于C组(33.33%),与B组相当(40.74%)。对阿司匹林、氯吡格雷均不敏感的患者换用进口波立维对提高血小板抑制效果更佳;仅对氯吡格雷不敏感的患者加用血府逐瘀胶囊对血小板抑制有协同作用。随访半年后发现,联合使用血府逐瘀胶囊的时间延长可能会增强血小板抑制的效果,但并不增加出血及凝血功能异常等风险。结论血府逐瘀胶囊对提高血小板抑制率有一定的作用,同时对出血风险影响较小。

Objective To observe and evaluate the regulating effect of Xuefuzhuyu capsule combined with clopidogrel on clopidogrel resistance.Methods After PCI operation,80 patients with clopidogrel resistance were randomly divided into three different treatments,A：clopidogrel（Tai Jia）combined with Xuefuzhuyu capsule;B：clopidogrel（Plavix）;C：clopidogrel（Tai Jia）combined with cilostazol.）After three months of continuous medication,and the inhibition rate of platelet aggregation was detected by thromboela-stogram（TEG）.The patients were followed up for half a year to observe the incidence of adverse events.Results After three months of treatment,the inhibition rates of the three groups were improved（P〈0.05）.The effective rate of platelet inhibition in group A was 40%（10/25）,which was higher to group C（33.33%）,and which was equivalent to group B（40.74%）.The effect of platelet aggregation inhibition was better in patients who were not sensitive to aspirin and clopidogrel and then with imported Plavix.And the treatment group of clopidogrel combined with Xuefuzhuyu capsule had a synergistic effect on platelet aggregation inhibition for clopidogrel insensitive patients.After six months′follow-up,it was found that the platelet inhibition was enhanced but the bleeding risk and abnormal coagulation function was not increased after prolonged using of Xuefuzhuyu capsule.Conclusion Xuefuzhuyu capsule had a certain effect on improving the inhibition rate of platelet aggregation,which had little effect on the risk of bleeding.