急性心肌梗死和冠脉支架术后再狭窄患者氯吡格雷抵抗相关因素分析  

Predictive factors of clopidogrel resistance in patients with acute myocardial infarction or coronary artery in-stent restenosis

作　　者：杨雅薇[1] 顾颖[1] 张云雁[1] 艾热夏提 张建[1] 赵仙先[1] 马丽萍[1] 

机构地区：[1]第二军医大学长海医院心血管内科,上海200433

出　　处：《临床军医杂志》2016年第5期470-476,共7页Clinical Journal of Medical Officers

基　　金：上海市科委基金(134119a0301)

摘　　要：目的探讨急性心肌梗死和冠脉支架内再狭窄患者双联抗血小板治疗后氯吡格雷抵抗的发生率及相关影响因素。方法对102例急性心肌梗死和冠脉支架内再狭窄的患者给予氯吡格雷治疗后,经Verify Now检测系统测定血小板功能。以Verify Now测试结果 P2Y12反应单位≥208定义为氯吡格雷抵抗。比较氯吡格雷抵抗患者和无氯吡格雷抵抗患者的一般临床资料、基因多态性、实验室指标和影像学特征差异,分析氯吡格雷抵抗的相关因素。结果氯吡格雷抵抗发生率为47.06%,两组在女性、年龄、全球急性冠状动脉事件注册危险（GRACE）评分、尿素氮、血红蛋白、红细胞计数、肌酸激酶同工酶（CKMB）、CYP2C19＊2基因型的差异有统计学意义（P〈0.05）。相关性分析显示,氯吡格雷抵抗与年龄、性别、尿素氮、肾小球滤过率、红细胞计数、血红蛋白、GRACE评分、GRUSADE评分、CYP2C19＊2纯合子基因型存在相关性（P〈0.05）,相关系数在0.2~0.5间。Logistic回归结果发现GRACE评分、CYP2C19＊2基因型、尿素氮可能是氯吡格雷抵抗的独立预测因素（P〈0.05）。结论 GRACE评分、CYP2C19＊2纯合子基因型、尿素氮可能是氯吡格雷抵抗的独立预测因素。Objective To investigate the incidence and influential factors of clopidogrel resistance in patients with acute myocardial infarction（AMI） or coronary artery in-stem restenosis （ISR）. Methods A total of 102 cases of patients with AMI or ISR were en- rolled, after receiving clopidogrel therapy, platelet function was evaluated by VerifyNow testing. P2Y12 reaction units（PRU） ≥208 were defined as clopidogrel resistance. The patients were divided into the clopidogrel-resistant group and clopidogre non-resistance group. The Baseline characteristics, gene polymorphism,laboratory and angiographic characteristics were compared between two groups. Inde- pendent predictive factors of clopidogrel resistance were explored by multiple factor analysis. Results The incidence of clopidogrel re- sistance in 102 cases of patients was 47.06%. Baseline characteristics, gene polymorphism,laboratory and angiographic characteristics were similar in clopidogrel resistance（ n = 48 ）and clopidogrel non-resistance group （n = 54）. There were significant differences be- tween treatment groups with regards to gender, age, urea nitrogen, hemoglobin, CK-MB, GRACE score and CYP2C19 ＊ 2 genotype （ P 〈 0. 05）. There were correlation between clopidogrel resistance and factors as age, gender, urea nitrogen, glomerular filtration rate, red blood cell count, hemoglobin, GRACE score, GRUSADE score and CYP2C19 ＊ 2 homozygote genotype. The correlation coefficient was 0.2 - 0. 5. In the further logistic regression analysis, CYP2C19 ＊ 2 homozygote genotype, GRACE score, urea nitrogen were found to be possibly predictors of clopidogrel resistance （P 〈 0. 05 ）. Conclusion CYP2C19 ＊ 2 homozygote genotype, GRACE score and Urea ni- trogen may be independent predictors of clopidogrel resistance in patients with AMI or ISR.

关 键 词：氯吡格雷抵抗 血小板功能检测 Verify Now系统 预测因素 

分 类 号：R541.4[医药卫生—心血管疾病]