氯吡格雷停减药对PCI术后患者血小板CD62P、CD63水平的影响  

The changes of platelet CD62P and CD63 concentrations after abrupt or gradual withdrawal of clopidogrel in patients underwent PCI

作　　者：蔡海鹏[1] 林祖近[1] 陈良友[1] 宋伟[1] 徐玉顺[1] 李招云[2] 

机构地区：[1]浙江省台州市中心医院心内科,318000 [2]浙江省台州市中心医院中心实验室,318000

出　　处：《心电与循环》2015年第1期28-30,56,共4页Journal of Electrocardiology and Circulation

摘　　要：目的观察PCI患者氯吡格雷骤停或逐渐减停后血小板CD62P、CD63水平的变化。方法冠状动脉药物洗脱支架(DES)植入术后服用阿司匹林、氯吡格雷双重抗血小板治疗12个月以上者共64例入组,其中对照组32例入选后即停服氯吡格雷;观察组32例隔天服氯吡格雷4周后完全停药。分别于入组时(0周)及入组后1、2、4、12周测定血小板溶酶体膜蛋白(CD62P)和血小板颗粒膜蛋白(CD63)水平,并随访6个月。结果对照组与观察组比较,1周时CD62P为(17.73±1.87)%vs(12.54±1.61)%,CD63为(16.85±1.53)%vs(12.66±1.32)%,2周时CD62P为(16.24±2.18)%vs(12.76±1.33)%,CD63为(15 96±1 75)%vs(12.87±1.29)%,差异均有统计学意义(P<0.05或0.01)。12周时两组CD62P、CD63水平较基础值升高(均P<0.05),而两组之间差异无统计学意义(均P>0.05)。随访6个月内无一例发生主要心血管不良事件(MACE)。结论停用氯吡格雷后存在明显的血小板活性反跳现象,采用先减量后停药的方法,可减少此现象的发生。Objective To observe the changes of platelet CD62P and CD63 concentrations after abrupt or gradual withdrawal of clopidogrel in patients underwent PCIl. Methods 64 patients being treated with dual antiplatelet drugs （aspirin and clopidogrel） more than 12 months after coronary drug- eluting stents implantation were enrol ed. Clopidogrel was stopped abruptly in 32 patients（control group） or taken every other day in 4 weeks and then stopped in other 32 patients （experimental group） . CD62P and CD63 were measured immediate before the study, and at 1,2,4 and 12 weeks later, respectively. They were fol owed up for 6 months. Results Compared with control group, CD62P and CD63 were significantly higher in experimental group at week 1 （17.73 ±1.87% vs 12.54 ±1.61%, 16.85 ±1.53% vs 12.66 ±1.32%, respectively, both P〈0.01 ） and week 2 （16.24±2.18%vs 12.76±1.33%, 15.96±1.75%vs 12.87±1.29%, both P〈0.05）. CD62P and CD63 were significantly higher at week 12 than baseline in both groups, with no significant difference between groups. No main adverse cardiovascular event occurred during 6- month fol ow- up. Conclusion Rebound platelet reactivity is evident after discontinuation of clopidogrel. Reducing the dose of clopidogrel fol owed by withdrawal may alleviate this rebound phenomenon.

关 键 词：氯吡格雷 血小板活性 反跳 CD63 CD63 

分 类 号：R541.4[医药卫生—心血管疾病]