氯吡格雷血小板反应性与经皮冠脉介入术后双联抗血小板治疗患者不良事件的关系  

Relationship Between Platelet Reactivity After Clopidogrel Treatment and Adverse Events of Patients Treated with Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

作　　者：张剑波 史琦玉 胡亚民[1] 李晓红[1] ZHANG Jianbo;SHI Qiyu;HU Yamin;LI Xiaohong(Cangzhou Central Hospital,Cangzhou,Hebei,China 061001)

机构地区：[1]河北省沧州市中心医院,河北沧州061001

出　　处：《中国药业》2024年第13期69-74,共6页China Pharmaceuticals

基　　金：河北省医学科学研究课题计划项目[20200310]。

摘　　要：目的探讨氯吡格雷血小板反应性与经皮冠脉介入术(PCI)后双联抗血小板治疗(DAPT)患者出血事件及心血管事件发生率的关系。方法回顾性收集医院2019年6月至2020年6月因冠状动脉粥样硬化性心脏病(简称冠心病)就诊并完成PCI且门诊随访的220例患者的临床资料,根据血小板聚集抑制率分为血小板低反应组(100例)和血小板高反应组(120例),并根据患者PCI后12个月是否发生出血分为出血组(41例)和未出血组(179例)。比较两组患者PCI后12个月的出血事件发生率及心血管事件发生率,分析DAPT评分、PRECISE-DAPT评分、血小板聚集抑制率、三者联合对患者出血风险的预测价值,采用Logistic回归分析法分析影响患者PCI后12个月发生出血的危险因素,构建列线图模型,并进行验证。结果PCI后12个月,血小板低反应组的心血管事件发生率为12.00%,明显高于血小板高反应组的4.17%(P<0.05);血小板低反应组的轻微出血发生率为20.00%,明显高于血小板高反应组的5.00%(P<0.05)。出血组DAPT评分明显低于未出血组(P<0.05),PRECISE-DAPT评分和血小板聚集抑制率均明显高于未出血组(P<0.05)。DAPT评分、PRECISE-DAPT评分、血小板聚集抑制率、三者联合检测预测出血风险的受试者工作特征曲线下面积(AUC)分别为0.833[95%CI(0.777,0.879)],0.641[95%CI(0.574,0.705)],0.891[95%CI(0.842,0.929)],0.949[95%CI(0.911,0.974)],对应的特异度分别为70.39%,77.09%,69.83%,86.59%,灵敏度分别为87.80%,48.78%,90.24%,92.68%。多因素Logistic回归分析显示,消化道溃疡史、DAPT评分、PRECISE-DAPT评分、血小板聚集抑制率均是PCI后12个月发生出血的影响因素(P<0.05)。列线图预测模型显示,DAPT评分每降低1分,增加10分的权重;PRECISE-DAPT评分每增加5分,增加5.2分的权重;血小板聚集抑制率每增加2分,增加10分的权重;有消化道溃疡史增加19.8分的权重。Bootstrap法内部验证显示,H-L检验结果为χ^(2)=7.54Objective To investigate the relationship between platelet reactivity after clopidogrel treatment and the incidence of bleeding events and cardiovascular events of patients treated with dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI).Methods The clinical data of 220 patients with coronary heart disease(CHD)who visited the hospital and successfully underwent PCI from June 2019 to June 2020 were retrospectively collected.According to the platelet aggregation inhibition rate,the patients were divided into the low platelet reaction group(100 cases)and the high platelet reaction group(120 cases),and the patients were divided into the bleeding group(41 cases)and the non-bleeding group(179 cases)based on whether bleeding occurred at 12 months after PCI.The incidence of bleeding events and cardiovascular events at 12 months after PCI between the two groups was compared,the predictive value of DAPT score,PRESISE-DAPT score,platelet aggregation inhibition rate,and three combined detection on the risk of bleeding in patients were analyzed.Logistic regression analysis was used to analyze the risk factors affecting bleeding at 12 months after PCI,the nomogram model was constructed and validated.Results Twenty months after PCI,the incidence of cardiovascular events in the low platelet reaction group was 12.00%,which was significantly higher than 4.17%in the high platelet reaction group(P<0.05).The incidence of mild bleeding in the low platelet reaction group was 20.00%,which was significantly higher than 5.00%in the high platelet reaction group(P<0.05).The DAPT score in the bleeding group was significantly lower than that in the non-bleeding group(P<0.05),and the PRESISE-DAPT score and platelet aggregation inhibition rate in the bleeding group were significantly higher than those in the non-bleeding group(P<0.05).The areas under the receiver operating characteristic curve(AUC)of predicting bleeding risk by the DAPT score,PRESISE-DAPT score,platelet aggregation inhibition rate,and three combined det

关 键 词：氯吡格雷血小板反应性 经皮冠脉介入术 双联抗血小板治疗 出血事件 

分 类 号：R969.3[医药卫生—药理学] R973.2[医药卫生—药学]