经皮冠状动脉介入治疗患者氯吡格雷抵抗的临床观察  

Clinical Study on Clopidogrel Resistance in Patients Undergoing Percutaneous Coronary Interventions

作　　者：张虎[1] 胡大一[1] 

机构地区：[1]北京大学人民医院心内科,北京100044

出　　处：《中国医药导刊》2005年第3期161-163,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:观察在经皮冠状动脉介入治疗(PCI)患者中硫酸氯吡格雷抵抗的发生情况。评价冠心病危险因素与氯吡格雷抵抗发生率的相关性,并进一步探讨氯吡格雷抵抗对。PCI后心肌损伤的影响。方法:68名接受PCI治疗的患者在服用氯吡格雷前,服药后24小时和服药后5天取血,利用电阻法分别测定ADP诱导的血小板聚集率,根据聚集率降低程度判断氯吡格雷抵抗发生率。采集患者冠心病危险因素资料,对各项因素与氯吡格雷抵抗发生率进行相关分析。测定PCI术前和术后的心肌酶(CK-MB、TnI)水平,对比两组患者心肌酶升高比例。结果:给予氯吡格雷负荷量后24小时氯吡格雷抵抗者为9例(13.2%);连续服药(75mg/d)5天后抵抗者为6例(8.8%)。两者间无显著性差异(P=0.412)。研究中观察的临床指标与氯吡格雷抵抗发生率无相关性。CK-MB升高在抵抗组发生率(77.8%)明显高于有效组(27.1%)(P=0.009)。TnI升高在抵抗组发生率(66.7%)同样明显高于有效组(20.3%)(P=0.011)。结论:PCI介入治疗的患者中存在部分氯吡格雷抵抗者。氯吡格雷抵抗的患者在接受PCI治疗后心肌酶升高比例增加,提示发生心肌损伤的危险高于氯吡格雷敏感者。Objective: To evaluate the prevalence of clopidogrel non - responders among patients undergoing percutaneous coronary intervention and investigate correlated factors. Furthermore, to compare the incidence of mvocardial damage between clopidogrel resistance and clopidogrel sensitive patients after percutaneous coronary intervention (PCI) . Methods: We examined ADP- induced platelet aggregation responses in 68 patients undergoing percutaneous coronary intervention. The whole patients were divided into clopidogrel resistance group and clopidogrel sensitive group according to clopidogrel responsiveness which determined by degree of pktelet inhibition. The incidence of myocardial damage was measured by creatine kinase - myocardial band (CK - MB) and by troponin I (TnI) eleva-tions in either group after PCI.Resuits: 9(13.2%) patients were noted to be clopidogrel resistance at 24 hours after 300 mg loading dose of clopidogrel, 6(8. 8%) patients to be clopidogrel resistance at 5 days after 75 mg maintenance dose. The risk factors observed in this study don't be correlation with clopidogre resistance except Braunwald grade. A significant difference was observed in comparison of CK - MB and TnI pre - and post - PCI. The incidence of any CK - MB elevation was 77.8% in clopidogrel resistance group and 27.1% in clopidogrel sensitive group (P = 0.009) . elevation of TnI was observed in 66.7% of clopidogrel resistance group and 20.3 % of clopidogrel sensitive group (P = 0.011). Conclusion: There were some clopidogrel non - responders among patients undergoing percutaneous coronary intervention. Despite adequate pretreatment with clopidogrel and aspirin, patients with clopidogrel resistance may have an increased risk of myocardial damage following PCI.

关 键 词：经皮冠状动脉介入治疗 氯吡格雷抵抗 临床观察 血小板聚集 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]