摘要
目的观察阿司匹林和（或）氯吡格雷治疗对冠心病患者血小板聚集率的影响，初步探讨抗血小板药物抵抗的相关因素。方法入选确诊为冠心病并已接受阿司匹林和（或）氯吡格雷治疗的患者160例，其中稳定性冠心病（SCHD）90例，急性冠脉综合征（ACS）70例，并选择未接受抗血小板药物治疗的非冠心病患者50例作为对照（NCHD）。记录研究对象的临床资料，采用连续血小板计数法测定花生四烯酸诱导的最大血小板聚集率（MAR—AA）和二磷酸腺苷诱导的最大血小板聚集率（MAR—ADP），分析冠心病患者抗血小板药物抵抗的发生率及其影响因素。结果与NCHD组相比，冠心病两组MAR—AA及MAR—ADP较低（P均〈0．05）。在ACS患者中，与单用阿司匹林组相比，双抗组MAR—AA与MAR—ADP均明显降低（P均〈0．05）。ACS组抗血小板药物抵抗的发生率明显高于SCHD组（20．0％VS10．0％，P〈0．05）。多因素Logistic回归分析显示，低水平HDL—C（〈1．0mmol／L）是药物抵抗的独立危险因素（OR=4．36，95％CI：1．36～14．02，P=0．014）。结论阿司匹林和（或）氯吡格雷治疗能有效降低冠心病患者的血小板反应性，在ACS患者中双抗血小板治疗抑制血小板聚集的作用更强，ACS患者抗血小板药物抵抗的发生率高于SCHD患者，HDL—C水平降低可能与抗血小板药物抵抗相关。
Objective To investigate the influence of aspirin and/or clopidogrel treatment on plate- let aggregation rate in coronary heart disease （CHD） patients, and discuss the factors related to anti-platelet drug resistance. Methods A total of 160 patients with CHD and received aspirin and/or clopidogrel treatment were enrolled in the Second Xiangya Hospital, Central South University, and were divided into stable coronary heart disease （ SCHD ） group （ n = 90 ） and acute coronary syndrome （ACS） group （ n = 70 ）. Meanwhile, non-coronary heart disease （NCHD） patients who did not receive anti-platelet drug treatment were enrolled as controls （n = 50）. Clinical data of the subjects were recorded. The maximum p｜atelet ag- gregation rate induced by arachidonic acid （MAR-AA） and adenosine diphosphate （MAR-ADP） were evaluated with sequential platelet counting method. The factors related to drug resistance were analyzed with Logistic regression analysis. Results Compared to NCHD group, there were lower MAR-AA and MAR-ADP in two groups of CHD （ all P 〈 0. 05）. In ACS patients, MAR-AA and MAR-ADP are significantly lower （P 〈0. 05） in patients who receive the aspirin and clopidogrel. The rate of anti-platelet drug resistance in ACS group was significantly higher than that in SCHD group （20. 0% vs 10. 0%, P 〈0. 05）. Multivariate logistic regression analysis showed that low HDL-C （ 〈 1.0 mmol/L） was an independent risk factor related to the anti-platelet drug resistance （ OR =4. 36, 95% CI： 1.36 - 14. 02, P = 0. 025）. Conclusions The antiplatelet treatment with aspirin and/or clopidogrel can significantly reduce the platelet reactivity in CHD patients, but some patients still present anti-platelet drug resistance. The combination of aspirin and clopidogrel is better. The rate of drug resistance in ACS patients is high. Low HDL-C might be associated with anti-platelet drug resistance.
出处
《中国医师杂志》
CAS
2017年第9期1366-1369,共4页
Journal of Chinese Physician
