冠心病合并慢性肾脏病患者P_(2)Y_(12)受体拮抗剂治疗进展

P_(2)Y_(12) Receptor Antagonist for Patients with Chronic Kidney Disease and Coronary Heart Disease

冠心病是慢性肾脏病患者的主要死亡原因。阿司匹林联合P_(2)Y_(12)受体拮抗剂的双联抗血小板治疗是冠心病管理的基石。冠心病合并慢性肾脏病患者兼具高血栓风险和高出血风险,因此双联抗血小板治疗面临严峻挑战。既往大多数冠心病临床研究常将严重的慢性肾脏病列入排除标准,因而临床医生管理冠心病合并慢性肾脏病患者时可参考的循证医学证据有限。现对近期冠心病合并慢性肾脏病患者应用P_(2)Y_(12)受体拮抗剂治疗相关研究进行综述,为临床医生选择P_(2)Y_(12)受体拮抗剂的种类、剂量和疗程提供依据。

Coronary heart disease(CHD)is the leading cause of deaths in patient with chronic kidney disease(CKD).Dual antiplatelet therapy with aspirin and P_(2)Y_(12) receptor antagonist is regarded as the cornerstone in respect of CHD management.Patients with CHD and CKD have high risk of thrombosis and hemorrhage,so the dual antiplatelet therapy is facing severe challenges.Nevertheless,CKD patients are usually excluded in most clinical experiments.As a result,evidence-based therapies are limited.This article reviews the recent research on the use of P_(2)Y_(12) receptor antagonist in patients with CHD and CKD,so as to provide a basis for clinicians to select the type,dose and course of treatment of P_(2)Y_(12) receptor antagonist.