他汀类药物对氯吡格雷抗血小板作用的影响

Effects of statins on the antiplatelet efficacy of clopidogrel

目的研究他汀类药物对氯吡格雷抗血小板作用的影响及不稳定型心绞痛患者氯吡格雷抵抗发生率。方法选择服用他汀类药物1个月以上的不稳定型心绞痛患者50例,其中普伐他汀组30例,其它他汀组20例。采用光比浊法分别检测患者服用氯吡格雷前和服用5d(75mg/d)后二磷酸腺苷诱导的血小板聚集率,据此计算用药前后聚集率差值、血小板聚集抑制率和氯吡格雷抵抗发生率。结果两组患者用药后二磷酸腺苷诱导的血小板聚集率[普伐他汀组(31.4±13.4)%、其它他汀组(26.6±9.9)%]均较用药前[普伐他汀组(52.8±13.0)%、其它他汀组(50.3±16.0)%]降低,差异均有统计学意义(t=5.63、5.90,均P<0.01)。两组患者用药后D值[普伐他汀组(21.4±18.3)%、其它他汀组(23.8±14.7)%]与血小板聚集抑制率[普伐他汀组(34.7±39.5)%、其它他汀组(41.8±30.8)%]差异均无统计学意义(t=0.49、0.67,均P>0.05)。氯吡格雷抵抗总发生率为26%。普伐他汀组无反应百分率与其它他汀组比较,差异无统计学意义(χ~2=2.11,P>0.05)。结论部分不稳定型心绞痛患者存在氯吡格雷抵抗。未发现经CYP3A4代谢的他汀类药物对氯吡格雷的抗血小板作用有影响。

Objective To investigate the interference of statins with the antiplatelet effect of clopidogrel and theincidence of clopidogrel resistance in patients with unstable angina pectoris.Methods Fifty inpatients with unstableangina pectoris were enrolled in the study.Among them,30patients took pravastatin(pravastatin group,PG)and20patients took another statins(non-pravastatin group,NPG).Platelet aggregation induced by adenosine diphosphate(ADP)was measured using optical aggregometry in all patients before and5days after administration of clopidogrel with adosage of75mg daily,and the change and percentage change of ADP-induced platelet aggregation were measured andcalculated.Results The ADP-induced platelet aggregation was significantly decreased from52.8±13.0%to31.4±13.4%in PG group and from50.3±16.0%to26.6±9.9%after taken of clopidogrel(all P<0.01).The different value andpercentage change of ADP-induced platelet aggregation after clopidogrel administration were not significantly differentbetween PG and NPG groups(21.4±18.3%and34.7±39.5%vs.23.8%±14.7%and41.8±30.8%,respectively,all P>0.05).Clopidogrel resistance occurred in26%patients with no significant difference between the two groups.ConclusionClopidogrel resistance is existed in some patients with unstable angina pectoris.This study does not confirm the influenceof statins metabolized via CYP3A4on the antiplatelet potency of clopidogrel.