冠状动脉介入术后患者血小板高反应性的影响因素分析  

Influential Factors Analysis on High Platelet Reactivity of Patients Undergoing Coronary Artery Stenting

作　　者：许盛松 郭玲玉[1] 张明亮[1] 周璇[1] 张俊峰[1] XU Sheng-song GUO Ung-yu ZHANG Ming-liang et al(Shanghai Ninth People＇s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai201999, China)

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,201999

出　　处：《心脑血管病防治》2016年第4期255-258,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨经皮冠状动脉介入术（percutaneous coronary intervention,PCI）后双联抗血小板治疗的冠心病患者血小板高反应性及其影响因素。方法选取在本院心内科住院并行PCI术的冠心病患者334例,术后接受100mg阿司匹林和75mg氯吡格雷治疗至少48小时,于晨起空腹抽外周静脉血通过血栓弹力图（thrombelastograph,TEG）检测血小板反应性。将二磷酸腺苷（Adenosine diphosphate,ADP）诱导的血小板抑制率30.00%作为临界值,分为氯吡格雷治疗后血小板高反应性（high platelet reactivity,HPR）组和血小板正常反应性（normal platelet reactivity,NPR）组。比较两组患者的基线资料、实验室指标和手术资料,并采用Logistic回归分析HPR的影响因素。结果 334例冠心病患者HPR的发生率44.90%,HPR单因素分析,在HPR与NPR组中的AA抑制率、血肌酐、性别、慢性肾功能不全、吸烟史比较差异有统计学意义（P〈0.05）,上述因素经条件Logistic回归分析显示AA抑制率升高（OR=0.98,95%CI：0.97~0.99,P〈0.01）和血肌酐升高（OR=0.98,95%CI：0.97~0.99,P〈0.01）为HPR的独立影响因素。结论 AA抑制率升高和血肌酐升高为HPR的独立影响因素。Objective To investigate the incidence and influential factors of high on-treatment platelet reactivity in patients undergoing dual antiplatelet therapy after percutaneous coronary intervention（ PCI）. Methods There were 334 patients with coronary heart disease（ CHD） receiving PCI in the Cardiology Department of our hospital. All patients had been given 100 mg aspirin and 75 mg clopidogrel per day for at least 48 hours after the interventional treatment. Thrombelastograph（ TEG） was used to record on-treatment platelet reactivity. Defining 30% of the platelet inhibition rate induced by adenosine diphosphate（ ADP） as the critical value,this research divided patients into a high on-clopidogrel treatment platelet reactivity（ HPR）group（ inhibition rate 〈30. 00%） and a normal platelet reactivity（ NPR） group（ inhibition rate 30. 00%）. The baseline data,laboratory examination results,and clinical data were compared between HPR and NPR. Logistic regression was applied to analyze the influential factors of HPR as well. Results The incidence of HPR in 334 CHD patients after PCI was 44. 90%.In univariate analysis of HPR,there were statistically significant differences in AA inhibition rate,serum creatinine level,gender,chronic kidney disease（ CKD）,and smoking history between HPR and NPR groups（ P 〈0. 05）. A conditional Logistic regression analysis showed that high levels of AA inhibition rate（ OR： 0. 98,95% CI： 0. 97 ~ 0. 99,P〈 0. 01） and high levels of serum creatinine（ OR = 0. 98,95% CI： 0. 97 ~ 0. 99,P 〈0. 01） were probably independent influential factors of HPR. Conclusions High levels of AA inhibition rate and High levels of serum creatinine were probably independent protective factors of HPR.

关 键 词：冠心病 经皮冠状动脉介入治疗 血小板高反应性 血栓弹力图 

分 类 号：R541.4[医药卫生—心血管疾病]