血小板高反应性对冠状动脉钙化患者介入术后发生主要不良心血管事件的研究  

Effect of high platelet reactivity on major adverse cardiac events in patients with coronary artery calcification after PCI

作　　者：申文彬[1] 白静[1] 杨霞[1] 孙婷[1] 汤喆[1] 刘漠焓[1] 任艺虹[1] 王禹[1] 苏绍萍[2] 

机构地区：[1]解放军总医院心内科,北京100853 [2]解放军总医院门诊部干部诊疗科,北京100853

出　　处：《中华老年心脑血管病杂志》2016年第2期153-157,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨血小板高反应性对冠状动脉钙化患者PCI术后发生主要不良心血管事件(MACE)的预测价值。方法回顾性分析行PCI患者264例,平均随访(367±64)d。根据冠状动脉造影有无靶病变钙化分为钙化组113例和非钙化组151例,所有患者均服用标准双联抗血小板药物(阿司匹林+氯吡格雷)治疗。二磷酸腺苷诱导的血小板高反应性(HPR)定义为血小板聚集率≥50%。结果钙化组患者HPR比例明显高于非钙化组(24.8%vs10.6%,P=0.002)。总体人群HPR患者MACE发生率较非HPR患者明显升高(27.3%vs 5.9%,P=0.000);钙化组HPR患者MACE发生率较非HPR患者明显升高(35.7%vs 7.1%,P=0.001);非钙化组HPR患者与非HPR患者MACE发生率比较,差异无统计学意义(12.5%vs 5.2%,P=0.244)。总体人群和钙化组HPR与MACE呈正相关(r=0.272,r=0.355,P<0.01)。非钙化组HPR与MACE无相关性(r=0.095,P=0.245)。HPR对MACE的危险度在总体人群、钙化组、非钙化组分别为OR=5.97(P<0.01)、OR=7.31(P<0.01)、OR=2.61(P>0.05)。结论 HPR对冠状动脉钙化患者PCI术后MACE有一定预测价值。Objective To study the effect of high platelet reactivity（HPR）on major adverse cardiac events（MACE）in patients with coronary artery calcification after PCI.Methods The clinical data of 264 patients with coronary artery calcification after PCI were retrospectively analyzed.The patients were divided into calcification group（n=113）and non-calcification group（n=151）,treated with aspirin plus clobigrel,and followed up for 367±64days.ADP-induced HPR was defined as the platelet aggregation rate≥50%.Results The incidence of HPR was significantly higher in calcfication group than in non-calcification group（24.8%vs 10.6%,P=0.002）.The incidence of MACE was significantly higher in HPR patients than in non-HPR patients and in calcfication group than in non-calcification group（27.3%vs 5.9%,P=0.000;35.7%vs 7.1%,P=0.001）.No significant difference was found in the incidence of MACE between HPR patients and nonHPR patients in non-calcification group（12.5%vs 5.2%,P=0.244）.HPR was positively related with MACE in calcification group and negatively related with MACE in non-calcification group（r=0.272,r=0.355,P〈0.01;r=0.095,P=0.245）.HPR was a risk factor for MACE in patients with coronary artery calcification after PCI（OR=5.97,P〈0.01;OR=7.31,P〈0.01;OR=2.61,P〉0.05）.Conclusion HPR can predict the MACE in patients with coronary artery calcification after PCI.

关 键 词：血小板聚集 冠状动脉疾病 趋化因子类 血小板聚集抑制剂 血小板活化因子 

分 类 号：R541.4[医药卫生—心血管疾病]