大剂量氯吡格雷治疗冠状动脉支架术后再狭窄及对血浆α-颗粒膜蛋白的影响  

Effects of high dose clopidogrel on coronary restenosis and plasma GMP-140

作　　者：苏子德[1] 张云[1] 常以芳[1] 

机构地区：[1]聊城市第二人民医院心内科,山东省临清252601

出　　处：《中华急诊医学杂志》2008年第1期65-68,共4页Chinese Journal of Emergency Medicine

基　　金：山东省卫生厅科研立项课题（2003HW019）

摘　　要：目的探讨不同剂量氯吡格雷治疗冠脉支架术后再狭窄（in-stentrestenosis，ISR）及对血浆α-颗粒膜蛋白（GMP-140）的影响。方法山东省聊城市第二人民医院心内科对100例急性冠脉综合症（acutecoronaxysyndrome，ACS）实施经皮冠状动脉介入（percutaneouscoronaryintervention，PCI）治疗，随机分为两组：对照组（n=50）和试验组（n=50）。对照组给予常规治疗（标准氯吡格雷疗法即术前3d服氯吡格雷300mg负荷量；随后75mg／a维持量），试验组给予大剂量氯吡格雷疗法（术前3天服氯吡格雷600mg负荷量，随后150mg／a维持量或75mg bid），余治疗与对照组相同。两组分别于术前、术后3个月、6个月采集外周静脉血，并分析两组血浆GMP-140的水平。所有患者术后6个月常规行冠状动脉造影（CAG）。所得数据用SPSS10．0统计软件分析处理。计量资料用均数±标准差（x±s）表示，组问资料采用t检验，P〈0．05为差异有统计学意义。结果术后3个月、6个月复查，对照组GMP-140较术前无明显降低（P〉0．05），试验组GMP-140较术前明显降低，差异具有统计学意义（P〈0．01）；两组术后相比，差异有统计学意义（P〈0．05）。CAG示：对照组ISR发生率10％，试验组ISR发生率2％，两组相比差异有统计学意义（P〈0．01）。两组均无严重不良反应发生。结论试验组ADP诱导的GMP-140表达较对照组明显降低，ISR发生率较对照组也明显降低，提示大剂量氯吡格雷能有效抑制血小板表面的GMP-140表达，从而能明显降低ISR发生率，且安全可靠。Objective To study effects of different doses of clopidogrel on coronary in-stent restenosis （ISR） and plasma GMP-140. Method A total of 100 patients with acute coronary syndrome （ACS） were treated in the Second People＇s Hospital of Liaocheng, China. They underwent percutaneous coronary intervention （PCI）, and were randomly divided into two groups： treatment groups （ n = 50） and control group （ n = 50）. The control group received routine therapy （300 mg loading dose clopidogrel 3 days before operation and followed by 75 mg daily）, while the treatment group received 600 mg loading dose clopidogrel 3 days before operation and followed by 150 mg daily or 75 mg twice a day. The other treatment was the same. Peripheral venous blood werecollected before operation, at 3 months and 6 months after operation, and the levels of plasma GMP-140 were measured. All the patients completed routine CAG. The data were expressed as （ ± s ）, and were analyzed by using Student＇s t test with SPSS 10.0. A P value less than 0.05 indicated statistical significance. Results Compared with before operation, the level of GMP-140 in control group didn＇ t decrease significantly at 3-month and 6-month follow-up （ P 〉 0.05）, while the levels of GMP-140 in treatment group significantly decreased （ P 〈 0.01）, and there were significant differences between two groups （ P 〈 0.05）. The occurrence rate of restenosis was 10% in control groups and 2% in treatment group, with P 〈 0.01. There were no serious side effects in two groups. Conclusion The level of GMP-140 and the occurrence rate of restenosis were significantly decreased in the treatment group. This suggests that high does clopidogrel can effectively inhibit the GMP-140, so decrease the occurrence rate of restenosis, and it＇s safe.

关 键 词：氯吡格雷 经皮冠状动脉介入 冠脉支架 再狭窄 Α-颗粒膜蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]