高维持剂量氯吡格雷对急性心肌梗死患者急诊介入术后血小板聚集率和高敏C反应蛋白水平的影响  

Impact of high maintenance dose of clopidogrel on clinical outcomes in ST-elevation myocardial infarction patients after primary percutaneous coronary intervention

作　　者：李靖[1] 王乐丰[1] 徐琳[1] 倪祝华[1] 葛永贵[1] 迟永辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,北京市100020

出　　处：《中国介入心脏病学杂志》2010年第1期16-20,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨对于急诊经皮冠状动脉介入治疗(PCI)后的急性ST段抬高性心肌梗死(STEMI)患者,增加氯吡格雷的维持剂量能否进一步降低腺苷二磷酸(ADP)诱导的血小板聚集率以及高敏C反应蛋白(hs-CRP)浓度,并影响临床预后。方法入选患者为2008年4月至11月在北京朝阳医院心脏中心行急诊PCI的STEMI患者。所有患者在PCI前均服用氯吡格雷600mg以及阿司匹林300mg。将支架置入成功的患者随机分为氯吡格雷高维持剂量组与标准维持剂量组,分别给予氯吡格雷150mg/d及75mg/d维持,7d后两组均以标准剂量维持。分别于服用负荷剂量前及服药7d时测定患者的血小板聚集率以及hs-CRP浓度。1个月时随访,比较两组之间临床终点事件发生率。结果共有100例患者入选本研究,高维持剂量组与标准维持剂量组各50例。(1)两组的基本临床特征、基线水平ADP诱导的血小板聚集率和hs-CRP浓度之间的差异均无统计学意义。(2)服药7d时氯吡格雷高维持剂量组的血小板聚集率显著低于标准维持剂量组(40.29%±22.47%比50.42%±21.39%,P=0.023)。(3)服药7d时高维持剂量组的hs-CRP下降程度显著高于标准维持剂量组(1.65±1.06mg/L比1.00±0.79mg/L,P=0.001)。(4)血小板聚集率的下降程度与hs-CRP下降程度之间存在相关性(r=0.21,P=0.043)。(5)经1个月随访,两组中均无患者死亡或再发心肌梗死;标准维持剂量组发生1例支架内血栓,但两组差异无统计学意义(2%比0,P=0.317);两组均无大出血及小出血发生,高维持剂量组有2例患者发生不显性出血,标准维持剂量组有3例,但两组间差异无统计学意义(4%比6%,P=0.648)。结论增加氯吡格雷维持剂量可以显著降低患者血小板聚集率及hs-CRP浓度。未发现增加氯吡格雷维持剂量能显著改善患者短期预后。Objective To study whether an increase in clopidogrel maintenance dose results in increased inhibition of platelet aggregation on patients after primary percutaneous coronary intervention （PCI） for acute ST-elevation myocardial infarction （STEMI）, and to assess whether a high maintenance dose of clopidogrel can attain an increasing reduction of hs-CRP concentration which can further influence clinical outcomes.Methods One hundred consecutive STEMI patients after primary PCI were enrolled in this study. They were randomized to receive clopidogrel 150 mg/day or 75 mg/day for 7 days.Platelet aggregation were evaluated at baseline and on the seventh day after PCI respectively with Thrombelastograph （TEG） and the hs-CRP concentration were assessed simultaneously. Patients were followed up for 30 days to record clinical outcomes. Platelet aggregation, hs-CRP concentration and clinical outcomes were analyzed. Results Baseline clinical and angiographic characteristics were similar between the 2 groups. Baseline platelet aggregation and baseline hs-CRP concentration were similar （P=0.871 and P=0.226,respectively）. High maintenance dose of clopidogrel was associated with a lower platelet aggregation （40.29±22.47% vs 50.42±21.39%,P=0.023） and a greater decrease in hs-CRP concentration （1.65±1.06 mg/L vs 1.00±0.79 mg/L, P=0.001）.There was a correlation between the inhibition of platelet aggregation and the decrease of hs-CRP level （r=0.21, P=0.043）. However, no significant clinical benefit was observed with high maintenance dose of clopidogrel. Conclusion Administration of a 150mg maintenance dose of clopidogrel results in more intense inhibition of platelet aggregation than administration of 75 mg maintenance dose. High maintenance dose of clopidogrel associated with greater decrease of hs-CRP level. However, no significant clinical benefit was acquired with high clopidogrel maintenance dose in short term evaluation.

关 键 词：心肌梗死 血小板聚集抑制剂 预后 

分 类 号：R542.22[医药卫生—心血管疾病]