中国临床实用医学
中國臨床實用醫學
중국림상실용의학
CHINA CLINICAL PRACTICAL MEDICINE
2010年
10期
17-19
,共3页
朱为勇%丁发明%张新丽%蔡尚郎
硃為勇%丁髮明%張新麗%蔡尚郎
주위용%정발명%장신려%채상랑
不稳定型心绞痛%经皮冠状动脉介入治疗%血小板聚集率%血小板P选择素%抑郁
不穩定型心絞痛%經皮冠狀動脈介入治療%血小闆聚集率%血小闆P選擇素%抑鬱
불은정형심교통%경피관상동맥개입치료%혈소판취집솔%혈소판P선택소%억욱
Unstable Angina Pectoris%Percutaneous Coronary Intervention%PAG%CD62P%Depression
目的 探讨抑郁对不稳定型心绞痛(USP)患者择期经皮冠状动脉介入治疗(PCI)后氯吡格雷药物反应的影响.方法 选取240例成功行PCI术的患者,分为抑郁组(117例)和非抑郁组(123例),PCI术前2 h给予氯吡格雷600 mg顿服,术后75 mg/d维持.分别于术前1 d内,术后1 d、5 d和1个月采血,以比浊法测定血小板凝集率(PAG),流式细胞仪测定血小板表面P选择素(CD62P)水平;比较两组患者随访12个月的重要心血管事件和非致死性卒中发生率.结果 PCI术前抑郁组比非抑郁组有较高的血小板聚集率(q=6.7613,P＜0.01)和P选择素水平(q=5.9827,P＜0.01),并且抑郁程度和血小板反应性存在线性关系(r=0.513,P＜0.05).术后1 d,5 d两组比较,血小板聚集率(q=7.9837,P＜0.01;q=6.8931,P＜0.01)和P选择素水平差异有统计学意义(q=11.8960,P＜0.01;q=7.4420,P＜0.01),并且氯吡格雷抵抗率两组差异有统计学意义(x2值为6.853,P=0.009;x2值为8.455,P=0.004),术后1个月持续抑郁组仍有较高的氯吡格雷抵抗率(x2值为4.861,P=0.027).结论 抑郁增强血小板凝集率和血小板活化程度,影响患者氯吡格雷药物反应.
目的 探討抑鬱對不穩定型心絞痛(USP)患者擇期經皮冠狀動脈介入治療(PCI)後氯吡格雷藥物反應的影響.方法 選取240例成功行PCI術的患者,分為抑鬱組(117例)和非抑鬱組(123例),PCI術前2 h給予氯吡格雷600 mg頓服,術後75 mg/d維持.分彆于術前1 d內,術後1 d、5 d和1箇月採血,以比濁法測定血小闆凝集率(PAG),流式細胞儀測定血小闆錶麵P選擇素(CD62P)水平;比較兩組患者隨訪12箇月的重要心血管事件和非緻死性卒中髮生率.結果 PCI術前抑鬱組比非抑鬱組有較高的血小闆聚集率(q=6.7613,P＜0.01)和P選擇素水平(q=5.9827,P＜0.01),併且抑鬱程度和血小闆反應性存在線性關繫(r=0.513,P＜0.05).術後1 d,5 d兩組比較,血小闆聚集率(q=7.9837,P＜0.01;q=6.8931,P＜0.01)和P選擇素水平差異有統計學意義(q=11.8960,P＜0.01;q=7.4420,P＜0.01),併且氯吡格雷牴抗率兩組差異有統計學意義(x2值為6.853,P=0.009;x2值為8.455,P=0.004),術後1箇月持續抑鬱組仍有較高的氯吡格雷牴抗率(x2值為4.861,P=0.027).結論 抑鬱增彊血小闆凝集率和血小闆活化程度,影響患者氯吡格雷藥物反應.
목적 탐토억욱대불은정형심교통(USP)환자택기경피관상동맥개입치료(PCI)후록필격뢰약물반응적영향.방법 선취240례성공행PCI술적환자,분위억욱조(117례)화비억욱조(123례),PCI술전2 h급여록필격뢰600 mg돈복,술후75 mg/d유지.분별우술전1 d내,술후1 d、5 d화1개월채혈,이비탁법측정혈소판응집솔(PAG),류식세포의측정혈소판표면P선택소(CD62P)수평;비교량조환자수방12개월적중요심혈관사건화비치사성졸중발생솔.결과 PCI술전억욱조비비억욱조유교고적혈소판취집솔(q=6.7613,P＜0.01)화P선택소수평(q=5.9827,P＜0.01),병차억욱정도화혈소판반응성존재선성관계(r=0.513,P＜0.05).술후1 d,5 d량조비교,혈소판취집솔(q=7.9837,P＜0.01;q=6.8931,P＜0.01)화P선택소수평차이유통계학의의(q=11.8960,P＜0.01;q=7.4420,P＜0.01),병차록필격뢰저항솔량조차이유통계학의의(x2치위6.853,P=0.009;x2치위8.455,P=0.004),술후1개월지속억욱조잉유교고적록필격뢰저항솔(x2치위4.861,P=0.027).결론 억욱증강혈소판응집솔화혈소판활화정도,영향환자록필격뢰약물반응.
Objective To evaluate the significance of depression on the effect of depression on the antiplatelet effect of clopidogrel in patients with USP treated with elective PCI.Methods The study group consisted of 240 patients with USP treated with elective PCI that was divided into two groups:Group A-117 patients with depression,including 81 persistently depressed patients and 36 remittent depressed patients,group B-123 persistently nondepressed patients,and the control group consisted of 20 healthy subjects.An ADP-induced lighttransmittance aggregometry( Chronolog Corp,USA)was used to measure the antiplatelet effect of clopidogrel,and the activated platelets CD62P was studied by flow cytometry.All of them were measured at baseline and at 1 day,5day and 1 month after PCI respectively.Results Preprocedural platelet aggregation and CD62P were higher in patients with depression than those in patients without depression.Post-procedural levels at day 1 and 5day showed a more decrease in patients without depression than in depression patients compared with preprocedural levels.The Patients with depression showed more clopidogrel resistance than patients without depression at 1 day and 5day after PCI.Furthermore,clopidogrel resistance was still found significantly higher in persistently depressed patients at 1 month after PCI.Conclusion Patients with USP suffering from depression show enhanced intravascular platelet activation,increased clopidogrel resistance.
