血栓弹力图评价急性冠状动脉综合征患者氯吡格雷反应低下的研究  

Clopidogrel resistance in patients with acute coronary syndrome by thromboelastograph

作　　者：赵黎佳[1] 魏欣[1] 杜凤和[1] 徐晓薇[1] 

机构地区：[1]首都医科大学附属北京天坛医院心内科,北京100050

出　　处：《临床内科杂志》2013年第2期105-108,共4页Journal of Clinical Internal Medicine

摘　　要：目的通过血栓弹力图（TEG）检测血小板聚集率，观察接受双联抗血小板药物治疗的急性冠状动脉综合征患者发生氯吡格雷反应低下的情况。方法选取住院的急性冠状动脉综合征患者167例，在常规口服阿司匹林（100ms／d）的基础上，随机给予氯吡格雷75mg／d或顿服300mg后继续75mg／d。常规剂量组在连续用药5天后、负荷组在顿服300mg后次日采血，通过TEG方法测定血小板聚集率，以二磷酸腺苷诱导的血小板聚集率I〉70％为氯吡格雷反应低下，花生四烯酸诱导的血小板聚集率〉50％为阿司匹林反应低下。结果总计50例患者出现氯吡格雷反应低下，发生率为29．9％，常规剂量组和负荷组比较差异无统计学意义（P〉0．05）；16例（9．6％）患者发生阿司匹林和氯吡格雷反应双低下；氯吡格雷反应低下组与非低下组问阿司匹林反应低下的发生率比较差异有显著统计学意义（P〈0．01）。氯吡格雷反应低下组与非低下组患者的年龄、高血压、糖尿病、合并用药等方面比较差异无统计学意义（P〉0．05），但两组性别、吸烟史、入院时总胆固醇水平比较差异具有统计学意义（P〈0．05）。结论接受标准抗血小板治疗的急性冠状动脉综合征患者存在氯吡格雷反应低下的现象，这一现象不受年龄、合并用药及氯吡格雷给药方式的影响，而女性、无吸烟史或烟龄短、年支数少、存在高总胆固醇血症或阿司匹林反应低下的患者更易发生氯吡格雷反应低下。Objective To investigate the incidence rate and influencial factors of elopidogrel resistance in patients with acute coronary syndrome. Method 167 patients with acute coronary syndrome were enrolled. All patients were treated regularly with aspirin 100 mg/d and were divided into two groups. Some patients were received a loading dose of 300 mg clopidogrel followed by a maintenance dose of 75 mg/d, and the others were prescribed with clopidogrel 75 mg/d. Platelet aggregation was measured by thromboelastograph（TEG） platelet mapping assay. Clopidogrel resistance was defined as 2lxmol/L adenosine diphosphate（ ADP）-induced aggregation/〉 70%, and aspirin resistance was defined as lmmol/L arachidonic acid （AA） -induced aggregation 〉 50%. Result Fifty （ 29.9% ） patients were resistant to clopidogrel. Sixteen（69.6% ） of the aspirin-resistant patients were also clopidogrel resistant. There was no significant difference of clopidogrel-resistance between the loading dose and routine dose patients （P 〉 0.05 ）. Clopidogrel-resistant patients had more non-smokers, female and hypercholesteremia（ P 〈 0.05 ）. Conclusion The incidence of clopidogrel resistant were 29.9% in acute coronary syndrome patients. There was no relationship between clopidogrel resistance and age or medication. Non-smokers, female, hy

关 键 词：血栓弹力图 急性冠状动脉综合征 氯吡格雷 

分 类 号：R543.3[医药卫生—心血管疾病]