高龄动脉粥样硬化性心血管病患者氯吡格雷抵抗的危险因素分析  

Risk Factors of Clopidogrel Resistance in the Elderly Patients with Atherosclerotic Cardiovascular Disease

作　　者：魏雅楠[1] 黎梦涵[1] 刘杰[1] 王晶桐[1] WEI Yanan;LI Menghan;LIU Jie;WANG Jingtong(Department of Geriatrics,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院老年科,北京100044

出　　处：《中国医学科学院学报》2023年第1期38-43,共6页Acta Academiae Medicinae Sinicae

基　　金：北京大学医学部大健康国际研究院项目(48014Y1017)。

摘　　要：目的探讨高龄动脉粥样硬化性心血管病患者氯吡格雷抵抗(CR)的高危因素,为其抗血小板治疗策略提供参考依据。方法选取2013年1月18日至2019年11月30日在北京大学人民医院老年科就诊的符合纳入标准的高龄(年龄≥80岁)动脉粥样硬化性心血管病患者223例。收集患者的相关临床资料及实验室检查,包括临床疾病情况、用药情况、体格检查、全血细胞分析、生化指标、血栓弹力图。根据血栓弹力图检测结果计算二磷酸腺苷诱导的血小板抑制率,并将患者分为CR组(n=84)和对照组(n=139),分析高龄动脉粥样硬化性心血管病患者CR的发生率及影响因素。结果223例患者中,CR发生率为37.7%,CR组患者血红蛋白明显低于对照组(t=3.533,P=0.001),而高血压患病率(χ^(2)=6.581,P=0.006)、多重用药比例(χ^(2)=3.332,P=0.048)、体重指数(BMI)(t=-2.181,P=0.030)、总胆固醇(t=-2.264,P=0.025)、甘油三酯(Z=-2.937,P=0.003)、低密度脂蛋白胆固醇(LDL-C)(t=-2.347,P=0.020)和女性比例(χ^(2)=5.562,P=0.014)均明显高于对照组。多因素Logistic回归分析显示,血红蛋白(OR=0.962,P<0.001)、BMI(OR=1.154,P=0.003)和LDL-C(OR=1.688,P=0.018)是高龄动脉粥样硬化性心血管病患者CR发生的独立相关因素。结论高龄动脉粥样硬化性心血管病患者CR的发生与血红蛋白、BMI和LDL-C水平独立相关。Objective To explore the risk factors of clopidogrel resistance(CR)in the elderly patients with atherosclerotic cardiovascular disease and to provide evidence for the antiplatelet therapy.Methods A total of 223 elderly patients(≥80 years old)with atherosclerotic cardiovascular disease treated in the Department of Geriatrics in the Peking University People’s Hospital from January 18,2013 to November 30,2019 and meeting the inclusion criteria were enrolled in this study.The clinical data and laboratory test results were collected,including clinical disease,drug use,physical examination,complete blood cell analysis,biochemical indicators,and thromboelastogram(TEG).The rate of platelet inhibition induced by adenosine diphosphate was calculated according to the TEG.We assigned the patients into a CR group(n=84)and a control group(n=139)to analyze the incidence and influence factors of CR in the elderly patients with atherosclerotic cardiovascular disease.Results The incidence of CR was 37.7%in the elderly patients with atherosclerotic cardiovascular disease.The CR group had lower hemoglobin(t=3.533,P=0.001)and higher hypertension prevalence rate(χ^(2)=6.581,P=0.006),proportion of multiple drugs(χ^(2)=3.332,P=0.048),body mass index(BMI)(t=-2.181,P=0.030),total cholesterol(t=-2.264,P=0.025),triglycerides(Z=-2.937,P=0.003),low-density lipoprotein cholesterol(LDL-C)(t=-2.347,P=0.020),and proportion of women(χ^(2)=5.562,P=0.014)than the control group.The results of multivariate Logistic regression showed that hemoglobin(OR=0.962,P<0.001),BMI(OR=1.154,P=0.003),and LDL-C(OR=1.688,P=0.018)were the factors influencing CR in the elderly patients with atherosclerotic cardiovascular disease.Conclusion Hemoglobin,BMI,and LDL-C may be independent factors associated with the occurrence of CR in the elderly patients with atherosclerotic cardiovascular disease.

关 键 词：氯吡格雷抵抗 血栓弹力图 高龄 

分 类 号：R541.4[医药卫生—心血管疾病]