不同剂量氯吡格雷预处理对经皮冠状动脉介入术的影响

Influence of different-dose clopidogrel pretreatment on percutaneous coronary intervention

目的观察不同氯吡格雷预处理剂量对经皮冠状动脉介入术（PCI）前血小板聚集率及术后心肌酶学指标的影响。方法临床纳入河南省平顶山市第二人民医院2013年1月～2015年1月间进行PCI的手术患者90例，根据患者术前氯吡格雷预处理剂量的不同分为低剂量组与高剂量组各45例。低剂量组入院时给予氯吡格雷300mg，高剂量组入院时给予氯吡格雷600mg，两组患者均氯吡格雷每日75mg维持。观察PCI手术前两组患者血小板聚集率以及术后心肌酶学指标的变化。结果低剂量组服药后2h、4h、6h、24h、72h血小板聚集率分别为（50.4±10.6）%、（48.3±9.8）%、（45.4±8.8）%、（45.9±8.6）%、（42.2±7.6）%，高剂量组服药后2h、4h、6h、24h、72h血小板聚集率分别为（45.2±9.2）%、（43.5±9.3）%、（41.0±8.1）%、（41.3±8.3）%、（41.0±7.9）%，高剂量组2h、4h、6h、24h血小板聚集率明显低于低剂量组，差异具有统计学意义（P＜0.05）；术后低剂量组肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）水平分别为（385.6±55.3）IU/L、（52.1±8.3）IU/L、（474.5±68.0）IU/L，高剂量组CK、CK-MB、LDH水平分别为（319.4±49.7）IU/L、（45.9±7.2）IU/L、（395.7±48.6）IU/L，差异具有统计学性意义（P＜0.05）。结论PCI术前对患者进行高剂量氯吡格雷预处理，能够显著降低血小板聚集率，且能够有效改善术后患者心肌酶学指标。

Objective To observe the influence of different-dose clopidogrel pretreatment on plateletaggregation rate (PAG) and myocardial enzyme indexes before percutaneous coronary intervention (PCI). MethodsThe patients undergone PCI (n=90) were chosen from Jan. 2013 to Jan. 2015, and divided into high-dose groupand low-dose group according to the doses of clopidogrel pretreatment. The low-dose group was given 300 mg ofclopidogrel and high-dose group was given 600 mg of clopidogrel at admission time, and then 2 groups were given75 mg of clopidogrel as maintain dose every day. The changes of PAG before PCI and myocardial enzyme indexesafter PCI were observed in 2 groups. Results In low-dose group, PAG was (50.4±10.6)%, (48.3±9.8)%, (45.4±8.8)%, (45.9±8.6)% and (42.2±7.6)%, respectively, after drug taking for 2 h, 4 h, 6 h, 24 h, and 72 h. In highdosegroup, PAG was (45.2±9.2)%, (43.5±9.3)%, (41.0±8.1)%, (41.3±8.3)% and (41.0±7.9)%, respectively,after drug taking for 2 h, 4 h, 6 h, 24 h, and 72 h. PAG was significantly lower in high-dose group than that inlow-dose group after taking drug for 2 h, 4 h, 6 h and 24 h (P<0.05). After PCI, the levels of creatine kinase (CK),creatine kinase MB (CK-MB) and lactic dehydrogenase (LDH) were, respectively, (385.6±55.3) IU/L, (52.1±8.3) IU/L, (474.5±68.0) IU/L in low-dose group, and (319.4±49.7) IU/L, (45.9±7.2) IU/L, (395.7±48.6) IU/L inhigh-dose group (P<0.05). Conclusion The clopidogrel pretreatment in a higher dose before PCI can significantlydecrease PAG, and effective improve myocardial enzyme indexes in patients undergone PCI.