我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

长期负荷量硫酸氢氯吡格雷显著降低血小板高反应性患者PCI术后心血管缺血事件发生率

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第6期
页码:
708-711
栏目:
临床研究
出版日期:
2015-07-15

文章信息/Info

Title:
Long-term loading dose of clopidogrel decreases recurrent cardiovascular ischemic events in patients undergoing percutaneous coronary intervention
作者:
林乐健; 唐发宽; 华 宁; 陆 宏; 唐雪正
(解放军第309医院心内科，北京 100091)
Author(s):
LIN Le-jian;  TANG Fa-kuan;  HUA Ning;  LU Hong;  TANG Xue-zheng
(Department of Cardiology, PLA 309 Hospital, Beijing 100091, China)
关键词:
硫酸氢氯吡格雷; 血栓弹力图; 经皮冠状动脉介入治疗; 心血管缺血事件
Keywords:
clopidogrel resistance;  thrombelastograph;  percutaneous coronary intervention;  cardiovascular ischemic events
分类号:
R973
DOI:
-
文献标识码:
A
摘要:
目的 观察长期负荷量使用硫酸氢氯吡格雷对血小板高反应性患者PCI术后心血管缺血事件发生率的影响。方法 采用血栓弹力仪检测硫酸氢氯吡格雷的药物效果，筛选PCI术后对硫酸氢氯吡格雷药物不敏感患者（血小板高反应性患者）作为研究对象，随机分为对照组及试药组，每组患者各60例，对照组每天服用100 mg阿司匹林及75 mg硫酸氢氯吡格雷，试药组服用100 mg阿司匹林以及150 mg硫酸氢氯吡格雷，检测6个月后硫酸氢氯吡格雷的药物效果，同时观察两组6个月内心血管事件的发生率。结果 6个月内试药组心血管病病死率、支架内血栓再形成率、再发心肌梗死和再发不稳定心绞痛发生率分别为0%、10%、23%以及6%，对照组为3%、20%、36%以及17%，试药组显著低于对照组，试药组硫酸氢氯吡格雷所致血小板抑制率明显高于对照组，两组患者出血风险无显著性差异。结论对于血小板高反应性患者,长期加倍剂量服用硫酸氢氯吡格雷可降低心血管缺血事件发生率。
Abstract:
AIM To investigate the effect of long-term loading dose of clopidogrel on the incidence of cardiovascular ischemic events in patients with high platelet reactivity who underwent percutaneous coronary intervention. METHODS Thrombelastograph was used to detect the effect of clopidogrel in 120 high platelet reactivity patients undergoing PCI and who were insensitive to clopidogrel. Patients were divided randomly into control group (n=60) and drug-test group (n=60). Patients in control group were given 100 mg of aspirin and 75 mg clopidogrel daily, and patients in drug-test group were given 100 mg of aspirin and 150 mg clopidogrel daily. A 6-month follow-up was conducted to examine the incidence of cardiovascular ischemic events. RESULTS After the 6-month antiplatelet therapy, the inhibition ratio of clopidogrel in drug-test group was significantly higher than in control group ［(68±5)% vs.(42±7)%, P<0.05］. The rate of occurrence of cardiovascular ischemic events including cardiovascular death, stent thrombosis, recurrent unstable angina and myocardial infarction in drug-test group was 0, 10, 23 and 6%, respectively, and decreased significantly compared with those in the control group (3, 20, 36 and 17%, respectively, P<0.05). CONCLUSION The maintenance loading dose of antiplatelet therapy with 150 mg clopidogrel daily can effectively decrease the rate of recurrent cardiovascular ischemic events.

参考文献/References

[1]Gurbel PA,Tantry US.Aspirin and clopidogrel resistance:consideration and management[J].J Interv Cardiol,2006,19(5):439-448.
[2]Cutlip DE,Baim DS,Ho KK,et al.Stent thrombosis in the modern era:a pooled analysis of multicenter coronary stent clinical trials[J].Circulation,2001,103(15):1967-1971.
[3]Geisler T,Schaeffeler E,Dippon J,et al.CYP2C19 and nongenetic factors predict poor responsiveness to clopidogrel loading dose after coronary stent implantation[J].Pharmacogenomics,2008,9(9):1251-1259.
[4]Buonamici P,Marcucci R,Migliorini A,et al.Impact of platelet reactivity after clop idogrel administration on drug-eluting stent thrombosis[J].Am Coll Cardiol,2007,49(24):2312-2317.
[5]Bonello L,Camoin-Jau L,Arques S,et al.Adjusted clopidogrel loading doses according to vasodilator-stimulated phosphoprotein phosphorylation index decrease rate of major adverse cardiovascular events in patients with clopidogrel resistance[J].J Am Coll Cardiol,2008,51(14):1404-1411.
[6]Shim CY,Yoon SJ,Park S,et al.The clopidogrel resistance can be attenuated with triple antiplatelet therapy in patients undergoing drug-eluting stents implantation[J].Int J Cardiol,2009,134(17):351-355.
[7]Barragan P,Bouvier JL,Roquebert PO,et al.Resistance to thienopyridines: clinical detection of coronary stent thrombosis by monitoring of vasodilator-stimulated phosphoprotein phosphorylation[J].Catheter Cardiovasc Interv,2003,59(3):295-302.
[8]Rivard GE,Brummel-Ziedins KE,Mann KG,et al.Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thromboelastography[J].J Thromb Haemost,2005,3(9):2039-2043.
[9]Khurana S,Mattson JC,Westley S,et al.Monitoring platelet glycoprotein IIb/IIIa-fibrin interaction with tissue factor-activated thromboelastography[J].J Lab Clin Med,1997,130(4):401-411.
[10]McCrath DJ,Cerboni E,Frumento RJ,et al.Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction[J].Anesth Analag,2005,100(6):1576-1583.
[11]Gurbel PA,Bliden KP,Guyer K,et al.Platelet reactivity in patients and recurrent events post-stenting:results of the PREPARE POST-STENTING Study[J].J Am Coll Cardiol,2005,46(10):1820-1826.
[12]Bates ER,Lau WC,Bleske BE.Loading,pretreatment,and interindividual variability issues with clopidogrel dosing[J].Circulation,2005,111(20):2557-2559.
[13]Oqueli E,Hiscock M,Dick R.Clopidogrel Resistance[J]. Heart Lung Circ,2007,16(suppl 3):S17-S28.
[14]Mega JL,Close SL,Wiviott SD,et al.Cytochrome p-450 polymorphisms and response to clopidogrel[J].N Engl J Med,2009,360(4):354-362.
[15]Simon T,Verstuyft C,Mary-Krause M,et al.Genetic determinants of response to clopidogrel and cardiovascular events[J].N Engl J Med,2009, 360(4):363-375.
[16]Gurbel PA,Bliden KP,Zaman KA,et al.Clopidogrel loading with eptifibatide to arrest the reactivity of platelets study[J].Circulation,2005,111(9):1153-1159.

备注/Memo

备注/Memo:
收稿日期：2015-01-28.
基金项目：解放军第309医院项目资助（2014MS-004）
通讯作者：唐发宽，主任医师，主要从事心血管疾病研究 Email：tfk616@sina.com
作者简介：林乐健，主治医师，硕士 Email：linlejian118@163.com
更新日期/Last Update: 2015-07-23