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|

冠心病患者PCI术后氯吡格雷抵抗的发生率及其影响因素

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第6期
页码:
661-664
栏目:
临床研究
出版日期:
2013-11-25

文章信息/Info

Title:
Clinical influence factors of clopidogrel resistance in patients with coronary heart disease after percutaneous coronary intervention
作者:
杨玉辉; 罗助荣; 黄明方; 曹小织; 章文莉; 刘东林; 郑卫星
(南京军区福州总医院心血管内科，福建 福州 350000)
Author(s):
YANG Yu hui;  LUO Zhu rong;  HUANG Ming fang;  CAO Xiao zhi;  ZHANG Wen li;  LIU Dong lin;  ZHENG Wei xing
(Department of Cardiology, Fuzhou General Hospital, Fuzhou 350000, Fujian, China)
关键词:
冠状动脉疾病; 血小板聚集率; 氯吡格雷抵抗; 冠状动脉介入治疗术
Keywords:
coronary disease;  platelet aggregation rate;  clopidogrel resistance;  percutaneous coronary intervention
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:探讨冠心病患者冠状动脉介入治疗术（PCI）后氯吡格雷抵抗的影响因素。方法:159例行PCI术治疗的冠心病患者，术前予氯吡格雷300 mg负荷剂量治疗，术后予75 mg/d持续治疗。测其服药前、术后24 h和术后5 d以5 μmol/L的二磷酸腺苷诱导的血小板最大聚集率。以血小板聚集抑制率≤10%定义为氯吡格雷抵抗，分为氯吡格雷抵抗组（抵抗组，n=48）和对氯吡格雷反应正常组（正常组,n=111），比较两组临床基本资料、相关常规检查、手术资料，Logistic回归分析氯吡格雷抵抗的独立危险因素。结果:159例患者中发生氯吡格雷抵抗48例，氯吡格雷抵抗发生率为30.2%。两组患者吸烟比例、并发糖尿病、三酰甘油水平的差异均有统计学意义(均P<0.05)，两组患者手术资料各项参数比较差异无统计学意义。Logistic回归分析结果显示氯吡格雷抵抗的独立危险因素有糖尿病、长期吸烟。三酰甘油水平无统计学意义。结论:糖尿病、长期吸烟是冠心病患者PCI术后发生氯吡格雷抵抗的独立危险因素。
Abstract:
AIM:To explore the influential factors of clopidogrel resistance in patients with coronary heart disease (CHD) who received percutaneous coronary interventions (PCI). METHODS: A total of 159 patients with CHD who underwent PCI were enrolled. Clopidogrel of 300 mg loading dose and 75 mg/day ongoing dose was administered before and after PCI. The 5 μmol/L adenosine diphosphate (ADP)induced maximum platelet aggregation rate (MPAR) was tested before administration as well as 24 h and 5 days after PCI. Patients were divided into clopidogrelresistant group (platelet aggregation rate ≤10%) and normal response group. Basic clinical data, related routine examination results, MARP and PCI characteristics were compared between groups and the independent risk factors of clopidogrel resistance were explored by logistic regression analysis. RESULTS: The incidence of clopidogrel resistance after PCI was 30% (40/159) in the 159 patients under study. Significant differences were found in patients with a long history of smoking, history of diabetes and triglyceride levels between groups (P<0.05), whereas no significant difference was observed in the PCI characteristics between groups. Logistic regression analysis revealed that history of diabetes and long history of smoking were independent risk factors of clopidogrel resistance but PCI characteristics were not related to clopidogrel resistance. CONCLUSION: Diabetes and long history of smoking may be risk factors for clopidogrel resistance in patients with CHD after PCI.

参考文献/References

[1]崔同涛,于汇民,董太明,等.二磷酸腺苷诱导血小板聚集率与急性冠状动脉综合征患者支架置入预后的关系[J].中国介入心脏病学杂志,2012,20(6):301-306.
[2]沈卫峰.“2013年ACCF/AHAST段抬高型心肌梗死处理指南”点评[J].国际心血管病杂志,2013,40(1):1-2.
[3]Muller I,Besta F,Schulz C,et al.Prevalence of clopidogrel nonrespenders among patients with stable angina pectoris scheduled for elective coronary stent placement[J].J Thromb Haemost,2003,89(5):783-787.
[4]Angiolillo DJ,Fernandez O,Bernardo E,et al.Platelet function profiles in patients with type 2 diabetes and coronary artery disease on combined aspirin and clopidogrel treatment[J].Diabetes,2005,54(8): 2430-2435.
[5]Hasan A,Hakan O,Ali K,et al.The effect of highdose clopidogrel treatment in patients with clopidogrel resistance (The EFFICIENT Trial)[J].Int J Cardiol,2012,157(3):374-380.
[6]Paul AG,Kevin PB,Bonnie LH,et al.Clopidogrel for coronary stenting response variability,drug resistance, and the effect of pretreatment platelet reactivity[J].Circulation,2003,107(23):2908-2913.
[7]杨 帆,赖沙毅,王 红.糖尿病患者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,2010,22(3):390-392.
[8]Turgay C,Atila I,Husamettin G,et al.Clopidogrel resistance:A diagnostic challenge[J].Int J Cardiol,2009,133(2):267-268.
[9]Pena A,Collet JP,Hulot JS,et al.Can we override clopidogrel resistance?[J].Circulation,2009,119(21):2854-2857.
[10]Wang XD,Zhang DF,Liu XB,et al.Modified clopidogrel loading dose according to platelet reactivity monitoring in patients carrying ABCB1 variant alleles in patients with clopidogrel resistance[J].Eur J Intern Med,2012,23(1):48-53.
[11]马颖艳,韩雅玲.冠脉介入治疗时期氯吡格雷抵抗的认识与思考——抓住本质,全面获益[J].心血管病学进展,2011,32(5):663-666.
[12]Angiolillo DJ,Bernardo E, Ramfrez C, et al. Insulin therapy is associated with platelet dysfunction in patients with type 2 diabetes mellitus on dual oral antiplatelet treatment[J].J Am Coll Cardiol,2006,48(2):298-304.
[13]Golbidi S,Badran M,Laher I.Antioxidant and antiinflammatory effects of exercise in diabetic patients[J].Exp Diabetes Res,2012,2012:941868.
[14]Preis SR,Hwang SJ,Coady S,et al.Trends in allcause and cardiovascular disease mortality among women and men without diabetes mellitus in the Framingham Heart Study, 1950 to 2005[J].Circulation,2009,119(13):1728-1735.
[15]Rajat SB,Fridolin S,Sundararajan S,et al.Acute cigarette smoke exposure reduces clot lysis association between altered fibrin architecture and the response to tPA[J].Thrombosis Res,2010,126(5):426-430.
[16]Ramzi A,Peter JG.Coagulation and atherothrombotic disease[J].Atherosclerosis,2006,186(2):240-259.
[17]黄婷婷,陈劲松,张明多,等.冠心病合并高血压患者氯吡格雷抵抗危险因素的Logistic回归分析[J].军医进修学院学报,2012,33(5):457-459.
[18]张春英,侯旭敏,仇兴标.冠心病PCI术后发生氯吡格雷抵抗的影响因素[J].上海交通大学学报(医学版),2012, 32(6):792-795.

备注/Memo

备注/Memo:
收稿日期：2013-06-03.基金项目：南京军区科技人才培养工程重点项目资助（12RC04）；南京军区福州总医院2012年基金资助项目（Y201203） 通讯作者：郑卫星，主任医师，主要从事冠心病的临床和基础研究 Email:zwx59321@126.com 作者简介：杨玉辉，主治医师，博士 Email:yangyuhui008@126.com
更新日期/Last Update: 2013-11-20