摘要
目的:评估血尿酸对行经皮冠状动脉介入治疗(PCI)后服用氯吡格雷患者血小板反应性的影响,以及整体患者和不同血尿酸水平患者中,血小板反应性与不良临床终点事件的相关性。方法:连续纳入2013年1月至12月于阜外医院行PCI的冠心病患者10 724例,排除无血栓弹力图者,研究最终纳入患者6 784例。高尿酸血症定义为男性血尿酸>7 mg/dl,女性>6 mg/dl。血小板高反应性(HTPR)定义为血栓弹力图腺苷二磷酸诱导的血小板-纤维蛋白凝块强度(TEG-MAADP)>47 mm。主要研究终点为主要不良心脑血管事件(MACCE)和出血。采用Logistic回归分析血小板反应性的影响因素,多因素Cox回归分析血小板反应性与长期预后的相关性。结果:6 784例患者中,1 406例(20.7%)患有高尿酸血症。2 073例(30.6%)患者存在HTPR,其中高尿酸血症患者447例(31.8%),非高尿酸血症患者1 626例(30.2%),高尿酸血症患者中HTPR发生率略高于非高尿酸血症患者,但差异无统计学意义。Logistic回归分析表明,校正基线混杂因素后,血尿酸水平不影响PCI后服用氯吡格雷患者的血小板反应性(HR=0.994,95%CI:0.951~1.039,P=0.790)。经随访2年后,Cox回归分析显示,校正基线混杂因素后,MACCE发生率在HTPR患者与非HTPR患者中差异无统计学意义(HR=0.97,95%CI:0.73~1.29,P=0.821),在高尿酸血症患者与非高尿酸血症患者中差异亦无统计学意义。然而,在高尿酸血症患者中,HTPR患者与非HTPR患者相比,其2年出血风险显著降低(HR=0.39,95%CI:0.17~0.92,P=0.030)。结论:尿酸水平与PCI后服用氯吡格雷患者的血小板反应性无明显相关;在高尿酸血症患者中,HTPR与远期出血风险降低相关。
Objectives:To evaluate the impact of uric acid(UA)on platelet reactivity,and long-term prognostic value of platelet reactivity in patients post percutaneous coronary intervention(PCI)and treated with clopidogrel.Methods:After excluding patients without thromboelastography(TEG)results,a total of 6 784 patients post PCI and treated with clopidogrel during January to December 2013 were enrolled in this study.All patients were followed up for 2 years.Hyperuricemia was defined as uric acid>7 mg/dl in male and>6 mg/dl in female.High on-treatment platelet reactivity was defined as TEG-ADP-induced platelet-fibrin clot strength(MAADP)>47 mm.The endpoints include major adverse cardiovascular and cerebrovascular events(MACCE)and bleeding.Logistic regression was used to evaluate risk factors for platelet reactivity.Multivariable Cox regression was used to evaluate the long-term prognostic effect of platelet reactivity.Results:There were 1 406 patients with hyperuricemia,and 5 378 patients with non-hyperuricemia.There were 2 073 patients with HTPR(30.6%).HTPR rate was 31.8%in hyperuricemia group and 30.2%in non-hyperuricemia group(P=0.259).Logistic regression showed that,after adjusted for confounding factors,uric acid level was not associated with platelet reactivity treated with clopidogrel(HR=0.994,95%CI:0.951-1.039,P=0.790).During the 2 years follow-up period,Cox regression analysis showed no difference between platelet reactivity and MACCE(HR=0.97,95%CI:0.73-1.29,P=0.821).While in patients with hyperuricemia,2-year bleeding risk was significantly lower in patients with HTRP than in patients with non-HTRP(HR=0.39,95%CI:0.17-0.92,P=0.030).Conclusions:UA is not associated with platelet reactivity in patients treated with dual antiplatelet therapy(DAPT)with clopidogrel after PCI.Platelet reactivity is associated with long-term bleeding risk in patients with hyperuricemia.
作者
蒋萍
宋莹
许晶晶
唐晓芳
姚懿
姜琳
王欢欢
赵雪燕
高展
陈珏
宋雷
高立建
张茵
杨跃进
高润霖
乔树宾
徐波
袁晋青
JIANG Ping;SONG Ying;XU Jingjing;TANG Xiaofang;YAO Yi;JIANG Lin;WANG Huanhuan;ZHAO Xueyan;GAO Zhan;CHEN Jue;SONG Lei;GAO Lijian;ZHANG Yin;YANG Yuejin;GAO Runlin;QIAO Shubin;XU Bo;YUAN Jinqing(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第7期658-663,共6页
Chinese Circulation Journal
基金
国家重点研发计划资助(2016YFC1301301)
国家自然科学基金(81770365)
