高维持量氯吡格雷对择期经皮冠状动脉介入患者术后临床效果的评价  

High maintenance dose of dopidogrel improves long-term clinical outcomes in patients with elective percutaneous coronary intervention

作　　者：任利辉[1] 彭建军[1] 徐雪丽[1] 叶慧明[1] 贾凯英[1] 

机构地区：[1]北京世纪坛医院心内科,100038

出　　处：《中华医学杂志》2012年第6期408-410,共3页National Medical Journal of China

摘　　要：目的评价氯吡格雷300mg负荷量后给予150mg维持量治疗对择期经皮冠状动脉介入（PCI）患者的长期临床效果。方法2007年7月至2008年7月前瞻性入选108例成功行PCI的患者，完成试验101例。所有患者于术前顿服300mg负荷量氯吡格雷，术后按随机数字表分组随机接受每日75mg（n=55）或150mg（n=46）维持量的氯吡格雷治疗30d，30d后所有患者接受每日75mg的氯吡格雷治疗直至术后6个月。分别测定术后30和60d的血小板抑制率，随访终点包括因心血管疾病而死亡，非致死性心肌梗死（MI）以及靶血管的血运重建（TVR）。结果术后30d150mg组血小板抑制率明显高于75mg组（64．2％±13．3％比52．6％±14．3％，P=0．00），平均随访时间为6个月。2组各死亡1例。150mg组MI[1例（1．8％）比3例（6．5％），P=0．405]及再次血运重建发生率[4例（7．2％）比6例（13．0％），P=0．714]均低于75mg组。包括死亡、MI及’ⅣR的不良心脏事件发生率150mg组亦低于75mg组（13．0％比20．2％，绝对风险降低7．3％）。结论作为冠状动脉心脏病患者PCI术后的常规用药，给予150mg高维持量氯吡格雷可降低择期PCI患者术后长期发生不良事件的风险。Objective To evaluate the efficacy of a 300 mg loading dose of clopidogrel followed by 150 mg as maintenance dose in patients with percutaneous coronary intervention （PCI）. Methods A total of 108 consecutive patients undergoing elective PCI were recruited from our hospital from July ：2007 to July 2008. A 300 mg loading dose was administered prior to PCI. Then they were randomized to receive clopidogrel 75 mg （n =55） or 150 mg （n =46） daily for 30 days. From Day 30 to Month 6 post-operation, all of them received 75 mg/d clopidogrel and were followed up for a mean period of 6 months. Results Thirty days after PCI, the platelet inhibition of the 150 mg group was significantly higher than the 75 mg group （64.2% ± 13.3% vs 52.6% ± 14.3% , P =0.00）. The ratios of fatal or non-fatal myocardial infarction （MI） （ 1 （ 1.8% ） vs 3 （ 6. 5% ）, P = 0. 405 ） and target vessel revascularization （ TVR ） （ 4 （7. 2% ） vs 6（ 13.0% ）, P =0. 714）were significantly lower in the 150 mg group than those in the 75 mg group. So the overall incidence of MACE including death, MI and TVR was obviously lower in the 150 mg group than that in the 75 mg group （ 13.0% vs 20. 2%, absolute risk reduction 7.3% ）. Conclusion A high clopidogrel maintenance dose of 150 mg daily for the first month after PCI reduces the risk of long-term adverse events in patients with elective percutaneous coronary intervention.

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 氯吡格雷 

分 类 号：R542.22[医药卫生—心血管疾病]