急性冠脉综合征患者氯吡格雷抵抗与近期疗效的临床观察

摘要/Abstract

摘要： 目的检测急性冠脉综合征(acute coronary syndrome,ACS) 患者服用氯吡格雷治疗前后腺苷二磷酸(adenosine diphosphate, ADP) 诱导的血小板聚集率变化, 同时观察临床主要心血管事件发生率。方法测定88 名冠心病稳定型心绞痛患者和102 名ACS 患者服用氯吡格雷前与服用后第5 天ADP 诱导的血小板聚集率, 按照血小板聚集率的抑制程度分为无反应、低反应和正常反应组。同时观察单纯药物治疗和联合支架置入术治疗患者1 月内主要心血管事件发生率。结果服用氯吡格雷前, ACS 患者ADP 诱导的血小板聚集率明显高于稳定型心绞痛患者[(80.4 ±7.8) % vs (56.2±12.1) %, P<0.05]。ACS 患者服用氯吡格雷的过程中, 无反应患者、低反应患者的发生率分别是21.6 %、27.4 %。结论 ACS 患者呈现出血小板高聚集状态。服用氯吡格雷后血小板聚集率的抑制程度呈现明显个体差异。氯吡格雷无反应和低反应患者在治疗过程中, 心绞痛发生率明显高于氯吡格雷正常反应患者(P<0.05)。联合支架置入术患者心绞痛发生率低于单纯药物治疗患者(P<0.05)。

关键词: 急性冠脉综合征, 氯吡格雷, 血小板聚集率

Abstract: AIM: To detect ADP (adenosine diphosphate)-induced platelet aggregation rate of patients with acute coronary syndrome before and after clopidogrel treatment and survey the main cardiovascular events. METHODS: ADP-induced platelet aggregation rates of 88 cases stable angina pectoris patients and 102 cases acute coronary syndrome (ACS) patients were detected before and after 5 days clopidogrel treatment.Patients were divided into three groups:nonresponders, low responders and normal responders according to inhibition degree.The main cardiovascular events were recorded during a month among using simple drug treatment and ACS patients. RESULTS: ADP-induced platelet aggregation rate with ACS patients was much higher than that of patients with stable angina pectoris[(80.4 ±7.8) % vs (56.2 ± 12.1) %, P<0.05] before clopidogrel treatment.Incidence rates of nonresponders and low responders were 21.6 % and 27.4 % respectively during using clopidogrel treatment. CONCLUSION: Patients with ACS have a higher platelet aggregation state.Inhibition levels of platelet aggregation rate have significant inter-individual difference after clopidogrel treatment.Incidence rates of diaphragmatic angina in nonresponders and low responders were obviously higher than that in normal responders(P<0.05).Incidence rate of angina pectoris using drug-eluting stent implantation was lower than that using simple drug treatment (P<0.05).

Key words: acute coronary syndrome, clopidogrel, platelet aggregation ratio

中图分类号:

R541.4

陈碧莲, 解勤之, 李清. 急性冠脉综合征患者氯吡格雷抵抗与近期疗效的临床观察[J]. 中国临床药理学与治疗学, 2009, 14(3): 328-332.

CHEN Bi-lian, XIE Qin-zhi, LI Qing. Clinical observation of clopidogrel resistance and clinical outcomes on patients with acute coronary syndrome[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(3): 328-332.

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