急性冠状动脉综合征伴慢性肾脏病患者介入术后抗血小板药物抵抗研究  

Antiplatelet drugs resistance after percutaneous coronary intervention in patients with acute coronary syndrome and chronic kidney disease

作　　者：陈娜[1] 季汉华[1] 

机构地区：[1]北京大学民航总医院心内科,北京100123

出　　处：《临床心血管病杂志》2012年第10期750-754,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨急性冠状动脉综合征(ACS)伴慢性肾脏病(CKD)的患者经皮冠状动脉介入术后氯吡格雷和阿司匹林抵抗的发生情况。方法:将133例ACS患者根据肾功能情况分为3组:肾功能正常组(66例),轻度CKD组(50例),中重度CKD组(17例)。通过血栓弹力图检测比较3组患者服用氯吡格雷和阿司匹林后的血小板抑制率。结果:肾功能正常组,轻度CKD组与中重度CKD组抗血小板药物抵抗发生率分别为25.8%、44.0%和52.9%,后两组比较差异无统计学意义(P=0.532),但都明显高于肾功能正常组(P<0.05)。结论:伴CKD的ACS患者更易出现抗血小板药物抵抗,采用个性化抗血小板治疗,可以减少临床缺血事件的发生。Objective：To investigate the resistance of clopidogrel and aspirin in patients with acute coronary syndrome （ACS） complicated with chronic kidney disease （CKD） underwent percutaneous coronary intervention. Method：According to renal function in ACS patients, 133 cases were divided into 3 groups： normal renal function （n= 66）, mild CKD （n=50）, moderate/severe CKD （n= 17）. By thromboelastography tests, resistance of plate- let was compared among three groups of patients intaking clopidogrel and aspirin. Result： The anti-platelet drug resistance rate in normal renal function group, mild CKD group and moderate/severe CKD group were 25.8%, 44.0% and 52.9%, respectively. The resistance incidence of clopidogre[ and aspirin in patients with renal dys- function was significantly higher than the patients with normal renal function （P〈0.05）. The incidence of resist- ance to antiplatelet drugs did not show any difference in mild CKD and moderate/severe CKD groups （P= 0. 532）. Conclusion：The patients with ACS and CKD are more vulnerable to form anti-platelet drug resistance. Individualized antiplatelet therapy can reduce the resistance cidence against antiplatelet dugs.

关 键 词：冠状动脉综合征 急性 慢性肾脏病 氯吡格雷抵抗 阿司匹林抵抗 血小板聚集率 

分 类 号：R541.4[医药卫生—心血管疾病]