氯吡格雷低反应性与急性冠状动脉综合征患者再发缺血事件相关性研究  

Low response to clopidogrel is associated with recurrent ischemic events in acute coronary syndrome

作　　者：吴桂萍[1] 郑建勇[2] 王芳[1] 李田昌[3] 林兰芝[3] 董征[3] 薛临萍[1] 

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

出　　处：《临床荟萃》2008年第4期238-240,共3页Clinical Focus

摘　　要：目的探讨氯吡格雷低反应性与急性冠状动脉综合征(ACS)患者出院后1个月和6个月再发缺血事件的相关性。方法入选72例ACS患者。采用传统的光学血小板聚集仪分别在服用氯吡格雷前和服药后7天测定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(△A),将入选人群划分为低反应组31例和正常反应组41例。分别在出院后1个月和6个月电话随访两组患者再发缺血事件情况。结果1个月内共发生18起缺血事件,其中低反应组发生11例,正常反应组发生7例(χ2=3.191,P>0.05)。与正常反应组相比,低反应组心绞痛再发率较高(P=0.038),然而,两组之间总的再发缺血事件率差异无统计学意义(P>0.05)。6个月内共发生27起缺血事件,其中低反应组发生17例,正常反应组发生10例(χ2=6.983,P<0.05)。低反应组心绞痛再发率仍然明显高于正常反应组,且两组间总事件率差异有统计学意义(P<0.01)。Logistic多元回归分析显示血小板聚集抑制率为未来发生事件的独立预测因素(OR=0.979,P=0.039)。结论与正常反应组相比,氯吡格雷低反应性的患者6个月内再发缺血总事件的风险明显增加,血小板聚集抑制率为6个月内再发缺血事件的独立预测因素。Objective To investigate the relationship of clopidogrel response and recurrent ischemic events during one and six months after discharge of the patients with acute coronary syndrome（ACS）. Methods Seventy-two patients with ACS were eligible for this study. 10 μmol/L adenosine diphosphate induced platelet aggregation was measured before and seven days after clopidogrel treatment by the traditional optical aggregometry. According to the inhibition of platelet aggregation（△A）, the subjects were divided into low response group （31 cases） and normal response group （41 cases）. At the end of one and six months after discharge, the recurrent ischemic events in two groups were collected by telephone. Results One month follow-up results showed that the incidence of ischemia in low response group was higher than that in normal response group, 11 cases vs 7 cases（x^2 = 3.191, P 〉0.05）, the incidence of recurrent angina was higher, too（ P = 0. 038）. However, there was no statistic difference about the total recurrent ischemic events between two groups（ P 〉0.05）. Six month follow-up result showed that the incidence of ischemia in low response group was still higher than that in normal response group, 17 cases vs 10 cases（x^2= 6. 983, P 〈0.05）. Moreover,there was significant difference about the total recurrent angina events between two groups（ P 〈0. 001）. Logistic multivariable regression analysis showed that the inhibition of platelet aggregation was independently associated with clinical outcome（OR=0. 979, P =0. 039）. Conclusion Compared with normal response group,the risk of total recurrent ischemic events in low response group during six months is significantly increased. The inhibition of platelet aggregation is independently associated with six month outcome.

关 键 词：冠状动脉疾病 氯吡格雷 缺血事件 血小板聚集率 

分 类 号：R541.4[医药卫生—心血管疾病]