血液透析对行经皮冠状动脉介入治疗的患者合用阿司匹林及氯吡格雷抗血小板聚集的影响

Effect of Hemodialysis on Antiplatelet Aggregation of Patients Undergoing Percutaneous Coronary Intervention Combined with Aspirin and Clopidogrel

目的探讨血液透析(HD)对经皮冠状动脉介入治疗(PCI)后患者合用阿司匹林和氯吡格雷抗血小板聚集的影响,为临床PCI后HD患者的抗血小板治疗提供指导。方法选取2020年1月—10月于山西医科大学第二医院住院的行PCI的HD患者23例,所有患者均给予阿司匹林和氯吡格雷治疗,检测并分析HD前后血小板聚集率。根据二磷酸腺苷诱导后血小板聚集率是否>55%,分为氯吡格雷治疗后血小板高反应组(HPR)与血小板低反应组(LPR),分析导致血小板高反应性的危险因素,同时比较两组6个月主要心血管不良事件(MACE)发生率。结果经花生四烯酸诱导的HD前后血小板聚集率分别为7.7%±6.9%和13.2%±8.6%,经二磷酸腺苷诱导的HD前后血小板聚集率分别为32.0%±17.2%和40.6%±19.0%,HD后两种诱导剂诱导的血小板聚集率均明显升高,差异均具有统计学意义(P<0.01);并且透析前有6例(26.1%)患者表现为HPR,而透析后有9例(39.1%)患者表现为HPR。高脂血症、肾小球滤过率升高与HPR相关,具有统计学意义(P<0.05)。HPR组的MACE发生率为22.2%,明显高于LPR组的7.1%,但差异无统计学意义(P>0.05)。结论HD后患者血小板聚集率升高,表现出很高的HPR发生率,导致阿司匹林和氯吡格雷的抗血小板聚集疗效降低,其中高脂血症和肾小球滤过率升高与HPR发生相关。在HD患者中,HPR患者的MACE发生率明显高于LPR患者,但无统计学意义。

Objective To explore the effect of hemodialysis on antiplatelet aggregation of aspirin and clopidogrel in patients after PCI to provide guidance on antiplatelet therapy for hemodialysis patients after PCI.Methods 23 hemodialysis patients with chronic kidney disease underwent PCI in our hospital from January to October 2020 were enrolled.The platelet aggregation rates(PARs)of all patients with aspirin and clopidogrel before and after hemodialysis were detected and analyzed.According to whether PAR after adenosine diphosphate(ADP)induction was>55%,patients were divided into high on-treatment platelet reactivity(HPR)group and low on-treatment platelet reactivity(LPR)group after clopidogrel treatment.Risk factors leading to HPR were determined.Simultaneously the incidence of major adverse cardiovascular events(MACE)between two groups at 6 months was compared.Results Arachidonic acid-induced PAR before and after hemodialysis were 7.7%±6.9%and 13.2%±8.6%respectively,with ADP-induced PAR of 32.0%±17.2%and 40.6%±19.0%before and after.Two inductive agents induced PARs after hemodialysis were both increased(P<0.01).Meanwhile,6 patients(26.1%)showed HPR before dialysis,and 9 patients(39.1%)showed HPR after dialysis.Hyperlipidemia and increased glomerular filtration rate(GFR)were related to HPR(P<0.05).The incidence of MACE was higher in HPR group(22.2%)than LPR group(7.1%),yet the difference was not statistically significant(P>0.05).Conclusion The patients with increased PAR after hemodialysis show a high incidence of HPR,which results in a efficacy decrease of anti-platelet aggregation with aspirin and clopidogrel.Hyperlipidemia and increased GFR are related to the occurrence of HPR.Among HD patients,the incidence of MACE was significantly higher in HPR patients than LPR,yet without a statistically significant difference.