服用阿司匹林后血小板聚集功能对介入治疗后心肌坏死指标的影响  

Study on the relationship between aspirin resistance and incidence of myonecrosis after non-emergent percutaneous coronary intervention

作　　者：张妍[1] 梁静[1] 周玉杰[1] 袁慧[2] 张永志[2] 董磊[3] 

机构地区：[1]首都医科大学附属北京安贞医院十二病房,北京100029 [2]首都医科大学附属北京安贞医院检验科,北京100029 [3]首都医科大学附属北京安贞医院血脂标化室,北京100029

出　　处：《中华心血管病杂志》2005年第8期695-699,共5页Chinese Journal of Cardiology

摘　　要：目的研究阿司匹林抵抗(aspirin resistance,AR)现象在冠心病患者中的发生情况,以及对非急诊PCI手术后心肌坏死情况的影响.方法入选了256例口服阿司匹林100 mg≥7天的患者.所有患者入院后检测血小板聚集功能、心肌坏死标志物:肌酸激酶同工酶(CK-MB)和肌钙蛋白I(TnI).根据血小板聚集功能检测结果分为AR和阿司匹林敏感两组.PCI术前至少12 h前给予氯吡格雷300 mg负荷量和75 mg/d维持量,术后24 h内再次测定心肌坏死标志物.比较两组心肌坏死标志物升高的例数.结果入选256例患者中67例(26.2 %)存在AR.女性在AR组中的比例明显比敏感组高(52.2%比20.6%,P=0.0065).PCI术后,CK-MB升高情况:AR组38例(56.7%),阿司匹林敏感组42例(22.2%),P=0.012,TnI升高情况:AR组41例(61.2%),阿司匹林敏感组67例(35.4%),P=0.006,两组间差异有统计学意义.AR组中PCI术后CK-MB升高患者所占比例是阿司匹林敏感组的2.5倍.同样AR组中PCI术后TnI升高患者所占比例是阿司匹林敏感组的近2倍(1.73倍).经多元逐步回归检验患者是否存在对阿司匹林的抵抗现象是PCI术后CK-MB升高的独立预测指标(OR=2.5;95%可信区间为1.5～6.5;P=0.018).结论 AR现象在冠心病患者中确实存在,而且能显著增加非急诊PCI 治疗患者术后心肌坏死危险性.Objective To investigate the occurrence of aspirin resistance in coronary heart disease （CHD） patients and its influence on myonecrosis among patients undergoing non-emergent percutaneous coronary intervention （PCI）. Methods 256 CHD patients who have been on aspirin （ 100 mg/d） for at least 7 days were recruited based on aspirin responsiveness determination. All the patients were divided into two groups： aspirin-resistant group and aspirin-sensitive group. For all patients scheduled for non-emergent PCI, a loading dose of 300 mg of clopidogrel was given at least 12 h before PCI and a 75 mg maintenance dose was given every morning before and after PCI. The incidence of myonecrosis was evaluated by the levels of creatine kinase-myocardial band （CK-MB） and troponin Ⅰ （TnI） before and after PCI. Results Aspirin resistance was found in 67 （26. 2% ） patients and 189 （73.8%） patients were aspirin-sensitive. There was a significantly higher proportion of female subjects in the aspirin-resistant group. The incidence of any CKMB elevation was 38（56. 7% ） in aspirin-resistant group and 42（22. 2% ） in aspirin-sensitive group （P 〈 0. 01 ）. The elevation of TnI was observed in 41 （61.2%） of the aspirin-resistant group and in 67（35.4% ） of the aspirin-sensitive group （ P 〈 0. 05 ）. Multivariate analysis revealed that aspirin resistance was an independent predictor for CK-MB elevation after PCI （OR = 2.5; 95% CI 1.5 to 6.5;P 〈 0.05）. Conclusion Aspirin resistance exists in some CHD patients, which increases the risk of myonecrosis following non-emergent PCI.

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 阿司匹林抵抗 血小板聚集功能 心肌坏死 介入治疗后 阿司匹林敏感 冠心病患者 

分 类 号：R542.2[医药卫生—心血管疾病]