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|本期目录/Table of Contents|

老年冠心病介入治疗氯吡格雷抵抗的影响因素

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第2期
页码:
224-226
栏目:
临床研究
出版日期:
2010-12-10

文章信息/Info

Title:
Prevalence and risk factors of clopidogrel resistance after percutaneous coronary intervention in patients over 60 years of age
作者:
王苏; 程宇彤; 王茜; 赵秀清; 张冬花; 阙斌; 李志忠
首都医科大学附属北京安贞医院抢救中心,北京 100029
Author(s):
WANG Su;  CHENG Yu-tong;  WANG Qian;  ZHAO Xiu-qing;  ZHANG Dong-hua;  QUE Bin;  LI Zhi-zhong
Center of Emergency, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China
关键词:
药物洗脱支架; 氯吡格雷抵抗; 危险因素
Keywords:
drug-eluting stent;  clopidogrel resistance;  risk factors
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的: 探讨60岁以上老年冠心病患者行冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后氯吡格雷抵抗的发生率和影响因素。方法: 符合入选标准的患者208例，年龄61～80岁，根据对氯吡格雷的反应分为氯吡格雷抵抗组55例和氯吡格雷有反应组153例。 结果: 氯吡格雷抵抗的发生率26.4%。氯吡格雷抵抗组和有反应组血小板聚集率(platelet aggregation rate,PAR)分别为（57±6）%和（35±9）%（P<0.01）。多因素logistic回归分析提示Ⅱ型糖尿病［P=0.037, 优势比（OR）=2.053，95%置信区间1.045-4.034］是氯吡格雷抵抗的影响因素。结论: 60岁以上老年冠心病患者PCI术后氯吡格雷抵抗的发生率26.4%，Ⅱ型糖尿病是氯吡格雷抵抗的影响因素。
Abstract:
AIM: To assess the incidence and risk factors of clopidogrel resistance after percutaneous coronary intervention (PCI) with drug-eluting stent in patients >60 years of age. METHODS: The clinical data of 208 patients were collected, among whom 55 patients whose PAR >50% after PCI were assigned to the clopidogrel resistance group and the other 153 patients were assigned to the without resistance group. Correlation factors were analyzed and compared between groups. RESULTS: The incidence of clopidogrel resistance was 26.4% in elderly patients. The level of PAR was (57±6)% vs. (35±9)% (P<0.01) between the two groups after PCI. Multivariate logistic regression models found that the risk factor was diabetes mellitus (P=0.037, OR 2.053, 95% CI 1.045-4.034). CONCLUSION: The incidence of clopidogrel resistance is 26.4% after PCI with drug-eluting stent in patients >60 years of age, and diabetes mellitus is the risk factor for clopidogrel resistance.

参考文献/References

[1]Mauri L, Hsieh WH, Massaro JM, et al. Stent thrombosis in randomized clinical trials of drug-eluting stents［J］. N Engl J Med, 2007, 356(10):1020-1029.

[2]Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study［J］. Lancet, 2007, 369(9562):667-678.

[3]Snoep JD, Hovens MM, Eikenboom JC, et al. Clopidogrel nonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: a systematic review and meta-analysis［J］. Am Heart J, 2007, 154(2):221-231.

[4]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.

[5]杨帆,赖沙毅,王红. 经皮冠状动脉介入术后氯吡格雷抵抗的临床观察［J］. 心脏杂志， 2008, 20(6)：722-724.

[6]余长永，张勇，邹建军，等. 氯吡格雷抵抗原因及对策的研究进展［J］. 中国临床药理学与治疗学, 2009, 14(10):1168-1173.

[7]郝盼盼，陈玉国，张运. 氯吡格雷抵抗相关因素的研究进展［J］. 心血管病学进展， 2009， 30(6)：991-994.

[8]白艳艳，王长谦，周明成，等. 冠心病患者介入治疗后氯吡格雷抵抗的发生率及相关因素［J］. 心脏杂志， 2008, 20 (3)：313-315.

[9]Erlinge D, Varenhorst C, Braun O, et al. Patients with poor responsiveness to thienopyridine treatment or with diabetes have lower levels of circulating active metabolite, but their platelets respond normally to active metabolite added ex vivo［J］. J Am Coll Cardiol, 2008, 52(24):1968-1977.

备注/Memo

备注/Memo:
收稿日期：2010-03-05.通讯作者：李志忠，主任医师，主要从事冠心病介入治疗研究Email:lzzeagle2@sina.com 作者简介：王苏，主治医师，硕士Email:yanyazh@vip.sina.com
更新日期/Last Update: 2010-12-10