急性冠状动脉综合征患者氯吡格雷反应性的影响因素探讨  

The influential factors of response to clopidogrel in patients with acute coronary syndrome

作　　者：吴桂萍[1] 李田昌[2] 薛临萍[1] 郑建勇[3] 李远征[2] 王志超[2] 王芳[1] 

机构地区：[1]山西省人民医院,太原030012 [2]首都医科大学附属北京同仁医院心血管诊疗中心,北京100730 [3]泰达国际心血管病医院,天津300457

出　　处：《中国实用内科杂志》2008年第1期46-48,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨影响氯吡格雷治疗急性冠状动脉综合征(ACS)反应性的因素。方法采用传统的光学血小板聚集仪对2005年9月至2006年4月在首都医科大学附属北京同仁医院住院治疗的72例ACS患者分别在服用氯吡格雷前和服药后7d测定10μmol/L二磷酸腺苷诱导的血小板聚集率。根据血小板聚集抑制率(ΔA),将入选人群划分为低反应组和正常反应组。采用Logistic回归分析对可能影响到氯吡格雷反应性的因素进行统计分析。结果两组的基线特征显示与正常反应组相比,低反应组的体重指数、肥胖人群和ST段抬高心肌梗死的比例较低,高血压和糖尿病的比例较高(P均<0.05)。独立样本t检验的进一步分析证实除了肥胖,高血压、糖尿病以及ACS的种类对氯吡格雷反应性均存在影响(P<0.05)。Logistic多元回归分析发现高血压和服药前血小板聚集率(Apre)是影响氯吡格雷反应性的主要因素(OR分别为15.757和1.131,P<0.01)。结论高血压和Apre是影响氯吡格雷反应性的主要因素。Objective To identify the factors influencing the response to clopidogrel. Methods Seventy-two patients with acute coronary syndrome who were treated at Beijing Tongren Hospital from September,2005 to April,2006 were eligible for this study. 10 μmol/L ADP induced ptatelet aggregation was measured before and 7 days after clopidogrel treatment by the traditional optical aggregometry. According to the inhibition of platelet aggregation （△A）, the population was divided into low response group and normal response group. Then some factors possibly influencing the response to clopidogrel were analyzed by specific statistical methods. Results Baseline characteristic showed that compard with that of normal response group,the body mass index and the percentage of obesity and STEMI were lower in low response group,while its percentage of hypertension and diabetes were higher（P 〈 0. 05 ）. The further independent-sample T test also proved the impact of hypertension, diabetes and kinds of ACS except obesity on the response to clopidogrel （ P 〈 0. 05 ）. Logistic multivariable regression found that hypertension and Apre were the main factors influencing the response to clopidogrel（ OR = 15. 757 and 1. 131 respectively,P 〈0. 01 ）. Conclusion Hypertension and Apre are the main factors influencing the response to clopidogrel.

关 键 词：血小板聚集率 氯吡格雷反应性 影响因素 

分 类 号：R5[医药卫生—内科学]