氯吡格雷更换为替格瑞洛抗血小板聚集疗效的前后对比  

Before and after comparison of the anti-platelet aggregation effect of Clopidogrel replaced to Ticagrelor

作　　者：王光亮 吴雪梅[3] WANG Guang-liang;WU Xue-mei(Department of Internal Medicine-Cardiovascular,Huanggu Hospital District of Northeast International Hospital,Liaoning Province,Shenyang 110000,China;Department of Internal Medicine-Cardiovascular,Peking University International Hospital,Beijing 100000,China;Department of Pediatric Neurology,the First Hospital of Jilin University,Jilin Province,Changchun 130000,China)

机构地区：[1]东北国际医院皇姑院区心内科,辽宁沈阳110000 [2]北京大学国际医院心内科,北京100000 [3]吉林大学第一医院小儿神经科,吉林长春130000

出　　处：《中国当代医药》2020年第1期157-161,共5页China Modern Medicine

基　　金：国家自然科学基金资助项目(81801284)

摘　　要：目的探讨急性冠脉综合征患者氯吡格雷更换为替格瑞洛抗血小板聚集疗效的前后对比。方法选取2018年4~11月北京大学国际医院收治的31例急性冠脉综合征患者作为研究对象,所有患者采用氯吡格雷治疗后接受血栓弹力图二磷酸腺苷(ADP)抑制率检测(A阶段数据),然后停用氯吡格雷更换为替格瑞洛治疗后再次检测血栓弹力图ADP抑制率(B阶段数据),对比前后两次检测ADP抑制率的结果。将氯吡格雷更换为替格瑞洛后行血栓弹力图ADP抑制率检测,按照该检测的采血时间点距离最后1次服用氯吡格雷的时间间隔分为三组,第一组(24~<36 h),第二组(36~<96 h),第三组(≥96 h)。比较三组的一般资料和A、B阶段血栓弹力图ADP抑制率,并对其中24例患者行CYP2C19基因型检测。结果三组B阶段的血栓弹力图ADP抑制率均高于本组A阶段血栓弹力图ADP抑制率,差异有统计学意义(P<0.05)。24例行CYP2C19基因型检测的患者中(CYP2C19*1/*1)正常代谢型17例,17例中有10例(58.8%)服用氯吡格雷后ADP抑制率<30%,但这10例患者更换为替格瑞洛后ADP抑制率9例均升至50%以上。结论氯吡格雷更换为替格瑞洛具有更好的抗血小板聚集疗效,急性冠脉综合征患者服用替格瑞洛具有更好的抗血小板聚集的疗效,即使是基因正常代谢型的患者也可能存在氯吡格雷抵抗,更换为替格瑞洛后抗血小板聚集疗效好转。Objective To explore the comparison of anti-platelet aggregation effect of Clopidogrel replaced to Ticagrelor in patients with acute coronary syndrome.Methods Thirty-one patients with acute coronary syndrome treated in Peking University International Hospital from April to November 2018 were selected as the research objects,all patients received thromboelastomeric adenosine diphosphate(ADP)inhibition rate test(stage A data)after clopidogrel treatment,then discontinuing Clopidogrel and replaced it with Ticagrelor to test the ADP inhibition rate(stage B data)of the thromboelastometry chart again,the results of the ADP inhibition rate tests was compared.After the Clopidogrel was replaced with Ticagrelor,the ADP inhibition rate test was performed on the thromboelastometry chart,the test was divided into three groups according to the time interval between the blood collection time point and the last dose of Clopidogrel,the first group(24-<36 h),the second group(36-<96 h),and the third group(≥96 h).The general data of the three groups and the ADP inhibition rate of the thromboelastic diagrams at the A and B stages were compared,and CYP2C19 genotype was detected in 24 patients.Results The thromboelastomeric ADP inhibition rate of three groups in B stage was higher than that in A stage,the difference was statistically significant(P<0.05).17 of the 24 patients with CYP2C19 genotypes(CYP2C19*1/*1)were normal,among the 17 cases,10 cases(58.8%)took clopidogrel and the inhibition rate of ADP was less than 30%,however,the inhibition rate of ADP increased to more than 50%in 9 of the 10 patients after replacement with Ticagrelor.Conclusion The replacement of Clopidogrel with Ticagrelor has better anti-platelet aggregation effect,and the treatment of Ticagrelor in patients with acute coronary syndrome has better anti-platelet aggregation effect.Even in patients with normal metabolism,there may be resistance to Clopidogrel,and the anti-platelet aggregation effect is improved after replacement with Ticagrelor.

关 键 词：氯吡格雷 替格瑞洛 血栓弹力图 血小板 二磷腺苷抑制率 

分 类 号：R558.9[医药卫生—血液循环系统疾病]