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经皮冠状动脉介入术后氯吡格雷抵抗的临床观察(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第6期
页码:
722-724
栏目:
临床研究
出版日期:
2008-12-25

文章信息/Info

Title:
Clinical observation of clopidogrelresistance in patients undergoing percutaneous coronary intervention with clopidogrel
作者:
杨帆; 赖沙毅; 王红
广西医科大学第四附属医院柳州市工人医院心内科,广西 柳州 545005
Author(s):
YANG Fan;  LAI Shayi;  WANG Hong
Department of Cardiology, Fourth Affiliated Hospital, Guangxi Medical Univercity, Liuzhou 545005, Guangxi, China
关键词:
急性冠脉综合征; 经皮冠状动脉介入治疗; 血小板聚集; 氯吡格雷抵抗
Keywords:
acute coronary symptom;  percutaneous coronary intervention;  platelet aggregation;  clopidogrelresistant
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 观察因急性冠脉综合征（ACS）行冠状动脉介入治疗(PCI)患者应用氯吡格雷后血小板聚集率的变化及氯吡格雷抵抗的发生情况。方法 ACS患者37例，予氯吡格雷负荷量300 mg，继予75 mg/d维持，在服用氯吡格雷前，服药后2、4、6、24、48 h以及服药后30 d取血，测定ADP诱导的血小板聚集率，观察血小板聚集率变化并根据抑制程度判断氯吡格雷抵抗发生率。结果 给药后2、4、6、24、48 h及30 d时，氯吡格雷抵抗的发生率分别为62%、46%、32%、38%、49%和43%，氯吡格雷抵抗者用药后血小板抑制率明显低于反应者，其中1例抵抗者出现亚急性支架内血栓形成。结论 PCI治疗的部分患者中存在氯吡格雷抵抗。
Abstract:
AIM To examine the platelet aggregation and the prevalence of clopidogrelresistance among patients undergoing percutaneous coronary intervention (PCI). METHODS Thirtyseven patients with acute coronary symptom (ACS) who underwent PCI were treated with clopidogrel (300 mg, loading dose, followed with 75 mg/d). Platelet aggregation function was assessed before and 2, 4, 6, 24, 48 h and 30 d after clopidogrel treatment. RESULTS The ratio of clopidogrel resistance were 62%, 46%, 32%, 38%, 49% and 43% at different times, platelet inhibition was much lower in clopidogrel resistants than responders, and subacute instent thrombosis occurred in one patient with clopidogrel resistance. CONCLUSION Clopidogrelresistance may occur in some patients undergoing percutaneous coronary intervention.

参考文献/References

［1］ Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity［J］. Circulation, 2003, 107(23):2908-2913.

［2］ An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators［J］. N Engl J Med, 1993, 329（10）:673-682.

［3］ Muller I, Besta F, Schulz C, et al. Prevalence of clopidogrel nonresponders among patients with stable angina pectoris scheduled for elective coronary stent placement［J］. Thromb Haemost, 2003, 89(5):783-787.

［4］ Lau WC, Gurbel PA, Watkins PB, et al. Contribution of hepatic cytochrome P 450 3A4 metabolic activity to the phenomenon of clopidogrel resistance［J］. Circulation, 2004, 109(2):166-171.

［5］ Jaremo P, Lindahl TL, Fransson SG, et al. Individual variations of platelet inhibition after loading doses of clopidogrel［J］. J Inter Med, 2002, 252(3):233-238.

［6］ Soffer D, Moussa I, Harjai KJ, et al. Impact of angina class on inhibition of platelet aggregation following clopidogrel loading in patients undergoing coronary intervention: do we need more aggressive dosing regimens in unstable angina?［J］. Catheter Cardio vasc Interv, 2003, 59(1):21-25.

［7］ Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistanceis associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction［J］. Circulation, 2004, 109(25):3171-3175.

备注/Memo

备注/Memo:
收稿日期：2007-12-10.基金项目：广西壮族自治区卫生厅自筹经费科研课题项目资助 （Z2006228） 作者简介：杨帆，主治医师，硕士 Email:wzyyfgh99820@yahoo.com.cn
更新日期/Last Update: 2009-03-24