常规双重抗血小板治疗对经皮冠状动脉介入治疗术后患者血小板功能的影响  

Effects of routine antiplatelet therapy on platelet function after percutaneous coronary intervention

作　　者：施鸿毓[1] 梁明亭 吴义林[1] 骆峰 曲新凯[1] 陈晖[1] 方唯一[1] 仇兴标[1] SHI Hongyu;LIANG Mingting;WU Yilin;LUO Feng;QU Xinkai;CHEN Hui;FANG Weiyi;QIU Xingbiao(Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University. Shanghai 200030, China)

机构地区：[1]上海交通大学附属胸科医院心内科,上海200030

出　　处：《上海医学》2019年第1期4-7,共4页Shanghai Medical Journal

摘　　要：目的评估常规双重抗血小板治疗对经皮冠状动脉介入治疗(PCI)术后患者血小板功能的抑制作用。方法纳入541例于2014年1月1日—2015年12月31日在上海交通大学附属胸科医院行PCI的患者。所有患者按指南要求接受常规双重抗血小板治疗,在PCI术后次日抽外周静脉血,采用血栓弹力图检测花生四烯酸(AA)和二磷酸腺苷(ADP)诱导的血小板功能。以AA诱导的血小板聚集抑制率>70%为阿司匹林反应过度,50%～70%为阿司匹林反应正常,<50%为阿司匹林反应低下。ADP诱导的血小板聚集抑制率>50%为氯吡格雷反应过度,30%～50%为氯吡格雷反应正常,<30%为氯吡格雷反应低下。计算阿司匹林和氯吡格雷的应答情况。采用多因素logistics回归分析影响阿司匹林和氯吡格雷应答的独立危险因素。结果在541例患者中,367例(67.8%)阿司匹林反应过度,84例(15.5%)阿司匹林反应正常,90例(16.6%)阿司匹林反应低下;415例(76.7%)氯吡格雷反应过度, 86例(15.9%)氯吡格雷反应正常,40例(7.4%)氯吡格雷反应低下;279例(51.6%)阿司匹林和氯吡格雷均反应过度。多因素logistic回归分析未发现阿司匹林反应低下的独立危险因素(P值均>0.05),糖尿病史(OR=2.27,95%CI为1.133～4.545,P=0.021)和CRP>0.5μg/L (OR=2.72,95%CI为1.006～7.348,P=0.049)是氯吡格雷反应低下的独立危险因素。结论有糖尿病史和血CRP水平升高是PCI术后患者对氯吡格雷反应低下的独立危险因素。Objective To evaluate the inhibiting effects of routine antiplatelet therapy on platelet function of patients who underwent percutaneous coronary intervention(PCI). Methods Totally 541 patients who underwent PCI between January 1, 2014 and December 31, 2015 were recruited. The dual antiplatelet therapy with aspirin and clopidogrel was used in all the patients according to guideline. Arachidonic acid(AA) and adenosine diphosphate(ADP) induced platelet function was detected by thromboelastography(TEG) the day after PCI. AA-induced platelet inhibitor rate>70% was considered as aspirin over-response, 50%-70% as aspirin normal-response, and <50% as aspirin low-response. ADP-induced platelet inhibitor rate>50% was considered as clopidogrel over-response, 30%-50% as clopidogrel normal-response, and <30% as aspirin low-response. We then calculated the response rates of aspirin and clopidogrel. Multifactor logistics regression analysis was used to analyze the risk factors influencing the response of aspirin and clopidogrel. Results There were 367 patients(67.8%) with aspirin over-response, 84 patients(15.5%) with aspirin normal-response, and 90 patients(16.6%) with aspirin low response. There were 415 patients(76.7%) with clopidogrel over-response, 86 patients(15.9%) with clopidogrel normal-response and only 40 patients(7.4%) with clopidogrel low-response. Both aspirin and clopidogrel over-response were found in 279 patients(51.6%). No independent factors of aspirin response were found in multivariate logistic analysis(both P>0.05). Diabetes(OR=2.27, 95% CI: 1.133-4.545, P=0.021) and C-reactive protein elevation(OR=2.72, 95%CI: 1.006-7.348, P=0.049) were independent factors of clopidogrel low-response. Conclusion Diabetes and elevated C-reactive protein are independent factors of clopidogrel low-response after PCI.

关 键 词：血小板功能试验 血栓弹力描记术 经皮冠状动脉介入治疗 双重抗血小板治疗 

分 类 号：R541.4[医药卫生—心血管疾病]