氯吡格雷对稳定性冠心病患者甲襞微循环的影响

Effects of clopidogrel on nailfold microcirculation in patients with stable coronary artery disease

目的观察氯吡格雷对稳定型冠心病(SCAD)患者甲襞微循环的影响。方法采用回顾性队列研究的方法,将135例SCAD患者依据过去3个月内是否服用氯吡格雷分为两组,其中服用氯吡格雷的患者(氯吡格雷组)61例,未服用氯吡格雷的患者(对照组) 74例。进行甲襞微循环检测,观察两组患者甲襞微循环异常程度分布情况,并进一步分析形态、流态和袢周状态等11项指标变化。结果 (1)氯吡格雷组患者的甲襞微循环总积分显著低于对照组(P <0. 01),主要体现在流态积分的下降(P <0. 01),袢周积分下降(P <0. 05),形态积分组间无显著差异。(2)氯吡格雷组患者甲襞微循环中、重度异常的比例均显著低于对照组,甲襞微循环异常程度的组间总体差异显著(P <0. 01)。(3)氯吡格雷组患者的甲襞微循环11项指标中只有红细胞聚集程度低于对照组患者(P <0. 05),其余指标组间均无显著差异。结论 SCAD患者服用氯吡格雷可以改善甲襞微循环障碍。

AIM To investigate the effect of clopidogrel on nailfold microcirculation （NM） in patients with stable coronary artery disease （SCAD）. METHODS A retrospective cohort method was used in this investigation. One hundred and thirty-five SCAD patients were recruited and divided into two groups according to their administration of clopidogrel in the last 3 months： patients taking clopidogrel （n=61） and patients not taking clopidogrel （n=74）. Nailfold capillaroscopy was performed for each patient and the abnormal grade and evaluation score of 11 indicators of NM were compared between the two groups for the effect of clopidogrel on the NM in SCAD patients. RESULTS NM total scores in patients taking clopidogrel were significantly lower than those in patients not taking clopidogrel （ P〈0.01）, which was mainly caused by decline of the flow score and loop-week score （P〈0.01, P〈0.05）. The differences of morphology score and between the two groups were not significant. Both the proportions of moderately and severely abnormal NM were lower in patients taking clopidogrel, while the proportions of normal and mildly abnormal NM were higher than those in patients not taking clopidogrel （P〈0.01）. Overall differences of the abnormal degree of NM between the two groups was significant. Patients taking clopidogrel had a lower degree of erythrocyte aggregation compared with that in patients not taking clopidogrel （P 〈 0. 05 ）, but no significant difference was found in other indexes of NM between the two groups. CONCLUSION Clopidogrel may improve the NM abnormality of SCAD patients related to its role in reducing erythrocyte aggregation. However, this conclusion should be further proved by additional prospective and large sample randomized controlled studies.