氯吡格雷不同预处理时间对支架置入患者血小板激活的影响  

Effect of different duration of clopidogrel pretreatment on platelet activation in patients undergoing stenting

作　　者：刘芳[1] 刘加春[2] 王利军[2] 李金[1] 许晓东[3] 刘燕[1] 黄一宁[4] 王大明[2] 

机构地区：[1]卫生部北京医院神经内科,100730 [2]卫生部北京医院神经外科,100730 [3]卫生部北京医院血液内科,100730 [4]北京大学第一医院神经内科

出　　处：《中华外科杂志》2009年第6期411-414,共4页Chinese Journal of Surgery

基　　金：国家自然科学基金项目资助（30571915）

摘　　要：目的探讨氯吡格雷预处理时间不同对支架置人患者血小板激活的影响。方法2006年7月至2007年12月40例择期颈动脉或椎动脉支架置入术的患者分为两组：A组（n=24）术前服用氯吡格雷（75mg／d）／〉5d；B组（n=16）为3—4d。在支架术前即刻、术后0．5、18h和6d的外周血中，分别用流式细胞术测定单核细胞一血小板聚集体和纤维蛋白原受体、比浊法测定血小板聚集功能以及酶联免疫吸附法测定血清可溶性CD40配体。结果术后18hB组的单核细胞-血小板聚集体、纤维蛋白原受体及可溶性CD40配体均高于A组（分别14．59％掷8．70％，P=0．012；4．87％ vs 2．42％，P=0．024；5．79ug／L vs 2．64ug／L，P=0．020）。术后0．5h可溶性CD40配体B组高于A组（0．49ug／L vs 0．31ug／L，P=0．033）。结论支架置入术前应用75mg／d氯吡格雷3～4d可能达不到充分的血小板抑制，服用氯吡格雷超过5d将能获得较好的临床抗血小板效果。Objective To investigate the effect of two clopidogrel pretreatment duration on platelet activation in patients undergoing stenting. Methods From July 2006 to December 2007 40 elective carotid or vertebral artery stenting patients were assigned into two groups： Group A （n = 24 ）initiated clopidogrel （75 mg/d） ≥5 d before stenting; group B （n = 16）initiated 3-4 days. Platelet-monocyte aggregates and fibrinogen receptors analyzed by flow cytometric, and platelet aggregation tests using optical aggregometry, as well as serum soluble CD40 ligand quantified by enzyme-linked immunosorbent assay were assessed in peripheral blood samples obtained immediately before and at 0. 5, 18 h and 6 d after stenting. Results Platelet-monoeyte aggregates, fibrinogen receptors and serum soluble CD40 ligand were higher in group B than in group A （ 14. 59% vs 8. 70% ,P =0. 012;4. 87% vs 2.42% ,P =0. 024;5.79 ug/L vs 2. 64 ug/L, P =0. 020） at 18 h after stenting. Serum soluble CD40 ligand was higher in group B than in group A （0.49 ug/L vs 0. 31 ug/L,P = 0. 033 ） at 0. 5 h after stenting. Conclusions Premedication before stenting with clopidogrel 75 mg/d merely 3-4 d may be insufficient to achieve adequate platelet inhibition, whereas clopidogrel initiated at least 5 d could obtain preferable clinical antiplatelet efficacy.

关 键 词：颈动脉狭窄 氯吡格雷 支架 血小板激活 颈动脉 椎动脉 

分 类 号：R686[医药卫生—骨科学]