急性冠脉综合征患者氯吡格雷抵抗与平均血小板体积及预后的相关性  

Correlation of clopidogrel resistance on mean platelet volume and prognosis of patients with acute coronary syndrome

作　　者：吴天源[1] 李韶南[1] 罗义[1] 吕磊[1] 刘建峰[1] WU Tian-yuan;LI Shao-nan;LUO Yi;LV Lei;LIU Jian-feng(Guangzhou First People＇s Hospital,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院心血管内科,广州510180

出　　处：《岭南心血管病杂志》2018年第5期502-505,510,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金项目(项目编号:201611119319867)

摘　　要：目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者平均血小板体积(mean platelet volume,MPV)与氯吡格雷抵抗(clopidogrel resistance,CR)的相关性,并评价CR对经皮冠状动脉介入(percutaneous coro-nary intervention,PCI)治疗后12个月内心血管事件的预测价值。方法选取2014年3月到2016年6月入住广州市第一人民医院心内科的ACS患者218例,所有患者均给予氯吡格雷负荷剂量300 mg口服,75 mg/d维持。入院时及服用氯吡格雷5 d后抽取空腹静脉血检测血小板聚集率(PA),血小板聚集率≤10%定义为CR。将患者分为CR和非CR(NCR)两组,比较两组临床资料、MPV、血清学指标。应用Logistic多因素回归分析和受试者工作特征曲线(receiver operating characteristic curve,ROC)确定MPV与CR的相关性。记录并分析患者术后12个月内主要不良心血管事件(心绞痛、心肌梗死及死亡)发生情况。结果 MPV在CR组显著高于NCR组,差异有统计学意义[(8.2±0.6)fl vs.(7.2±0.8)fl,P<0.05]。Logistic多因素回归分析显示MPV是发生CR的独立危险因素。MPV预测CR的ROC显示,曲线下面积(AUC)为0.812(95%CI∶0.728～0.924,P<0.05);当MPV=8.6 fl时,MPV预测CR的灵敏度和特异度最佳,分别为81.68%和79.62%。PCI治疗后12个月的心血管事件发生率CR组显著高于NCR组,差异有统计学意义(11.1%vs. 1.4%,P<0.05)。结论 MPV升高与ACS患者CR的发生存在相关性;ACS患者发生CR增加PCI治疗后主要不良心血管事件发生的风险,影响ACS患者的临床预后。Objectives To investigate the con＇elation between mean platelet volume （MPV） and clopidogrel resistance （CR） in patients with acute coronary syndrome （ACS） , and to evaluate the predictive value of CR for cardiovascular events within 12 months after percutaneous coronary intervention （PCI）. Methods Totally 218 patients with ACS admitted to Department of Cardiology in Guangzhou First People＇ s Hospital from March 2014 to June 2016 were selected. All patients received clopidogrel with loading dose of 300 mg orally, and 75 mg/d maintained. Five days after admission and taking clopidogrel, fasting venous blood was taken to detect platelet aggregation rate （PA） , inhibition of PA as less than 10% is defined CR. Clinical data, MPV and biochemical indexes were compared between the two groups. Incidence of cardiovascular events （angina pectoris, myocardial infarction and death） was recorded and analyzed 12 months after the operation. Logistic regression analysis and receiver operating characteristic curve （ROC） were used to determine the con＇elation between MPV and CR. Results MPV in CR group was significantly higher than that in non CR gToup [ （8.2±0.6） pg/mL vs. （7.2±0.8） pg/mL, P〈0.05]. Incidence of cardiovascular events in CR group 12 months after PCI was much higher than that in non CR group （14% vs. 5.4%, P〈0.05）. Logistic regression analysis showed that MPV was an independent risk factor for CR. When MPV=8.6 fl, the sensitivity and specificity of MPV in predicting CR were the best, which were 82.68% and 79.62% respectively （0R=6.8 ; 95%CI：2.8-13.8, area under ROC ： 0.82,P〈0.05 ）. Conclusions MPV was associated with CR in patients with ACS. CR increased the risk of cardiovascular events in patients with ACS undergoing PCI treatments and affected the clinical prognosis of them.

关 键 词：冠状动脉疾病 平均血小板体积 氯吡格雷抵抗 血管成形术 经腔 经皮冠状动脉 心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]