中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2012年
8期
662-666
,共5页
林少沂%崔翰斌%陈晓敏%王胜煌%周宏林%杜为平%叶红华%潘伟民%杨锐%丰明俊%胡烨文%王勇%王世奇
林少沂%崔翰斌%陳曉敏%王勝煌%週宏林%杜為平%葉紅華%潘偉民%楊銳%豐明俊%鬍燁文%王勇%王世奇
림소기%최한빈%진효민%왕성황%주굉림%두위평%협홍화%반위민%양예%봉명준%호엽문%왕용%왕세기
冠状动脉疾病%血小板聚集抑制剂%抗药性%血小板功能试验
冠狀動脈疾病%血小闆聚集抑製劑%抗藥性%血小闆功能試驗
관상동맥질병%혈소판취집억제제%항약성%혈소판공능시험
Coronary disease%Platelet aggregation inhibitors%Drug resistance%Platelet function test
目的 临床评估常规剂量氯吡格雷的血小板抑制性,探讨氯吡格雷低反应的临床特征及其预测因素.方法 人选99例接受冠状动脉介入治疗并规律服用氯吡格雷1周以上的冠心病患者,通过VerifyNow-P2Y12系统检测氯吡格雷对血小板的抑制状况,并分别以血小板基线活性、P2Y12反应单位(PRU,代表血小板残余活性)及血小板抑制率来表示.详细记录所有入选者抗血小板药物的服用剂量和疗程、合并用药情况以及临床基线特征等.本研究以PRU≤240为标准,将氯吡格雷服用后血小板反应性分为正常反应及低反应(即氯吡格雷抵抗),后者进一步根据基线活性及抑制率水平分为Ⅰ型(即基线相关型,假性抵抗)、Ⅱ型(抑制率相关型,真性抵抗)和Ⅲ型(复合型)3种亚型.结果 99例受检患者中氯吡格雷抵抗者48例(48.5％),其中Ⅰ、Ⅱ和Ⅲ型抵抗分别为9例(9.1％)、27例(27.3％)和12例(12.1％)；与男性相比,女性患者血小板基线活性较高(P＜0.01),同时PRU增高的人群比例较高(P＜0.01),女性为Ⅰ型抵抗的预测因素(OR=6.500, 95％ CI2.295 ～ 18.407,P＜0.01)；而体质指数(BMI) ＞24 kg/m2与氯吡格雷血小板抑制率显著相关(P＜0.05),提示为Ⅱ型抵抗的预测因素( OR=3.207,95％CI1.375 ～7.485,P＜0.01).年龄、高血压、糖尿病、吸烟、高脂血症、C反应蛋白、合用泮托拉唑等因素与基线活性及血小板抑制率均无明显相关性.结论 VerfyNow-P2Y12系统检测提示,氯吡格雷Ⅰ型抵抗因血小板基线活性过高所致,女性为高基线活性的独立预测因素；Ⅱ型抵抗因血小板抑制率过低所致,与氯吡格雷药理作用减弱有关,超重为其影响因素；Ⅲ型抵抗同时存在高基线及低抑制率的特征；年龄、高血压、糖尿病、吸烟、高脂血症、C反应蛋白及合用质子泵抑制剂泮托拉唑等因素与氯吡格雷抵抗的发生无明显相关性.
目的 臨床評估常規劑量氯吡格雷的血小闆抑製性,探討氯吡格雷低反應的臨床特徵及其預測因素.方法 人選99例接受冠狀動脈介入治療併規律服用氯吡格雷1週以上的冠心病患者,通過VerifyNow-P2Y12繫統檢測氯吡格雷對血小闆的抑製狀況,併分彆以血小闆基線活性、P2Y12反應單位(PRU,代錶血小闆殘餘活性)及血小闆抑製率來錶示.詳細記錄所有入選者抗血小闆藥物的服用劑量和療程、閤併用藥情況以及臨床基線特徵等.本研究以PRU≤240為標準,將氯吡格雷服用後血小闆反應性分為正常反應及低反應(即氯吡格雷牴抗),後者進一步根據基線活性及抑製率水平分為Ⅰ型(即基線相關型,假性牴抗)、Ⅱ型(抑製率相關型,真性牴抗)和Ⅲ型(複閤型)3種亞型.結果 99例受檢患者中氯吡格雷牴抗者48例(48.5％),其中Ⅰ、Ⅱ和Ⅲ型牴抗分彆為9例(9.1％)、27例(27.3％)和12例(12.1％)；與男性相比,女性患者血小闆基線活性較高(P＜0.01),同時PRU增高的人群比例較高(P＜0.01),女性為Ⅰ型牴抗的預測因素(OR=6.500, 95％ CI2.295 ～ 18.407,P＜0.01)；而體質指數(BMI) ＞24 kg/m2與氯吡格雷血小闆抑製率顯著相關(P＜0.05),提示為Ⅱ型牴抗的預測因素( OR=3.207,95％CI1.375 ～7.485,P＜0.01).年齡、高血壓、糖尿病、吸煙、高脂血癥、C反應蛋白、閤用泮託拉唑等因素與基線活性及血小闆抑製率均無明顯相關性.結論 VerfyNow-P2Y12繫統檢測提示,氯吡格雷Ⅰ型牴抗因血小闆基線活性過高所緻,女性為高基線活性的獨立預測因素；Ⅱ型牴抗因血小闆抑製率過低所緻,與氯吡格雷藥理作用減弱有關,超重為其影響因素；Ⅲ型牴抗同時存在高基線及低抑製率的特徵；年齡、高血壓、糖尿病、吸煙、高脂血癥、C反應蛋白及閤用質子泵抑製劑泮託拉唑等因素與氯吡格雷牴抗的髮生無明顯相關性.
목적 림상평고상규제량록필격뢰적혈소판억제성,탐토록필격뢰저반응적림상특정급기예측인소.방법 인선99례접수관상동맥개입치료병규률복용록필격뢰1주이상적관심병환자,통과VerifyNow-P2Y12계통검측록필격뢰대혈소판적억제상황,병분별이혈소판기선활성、P2Y12반응단위(PRU,대표혈소판잔여활성)급혈소판억제솔래표시.상세기록소유입선자항혈소판약물적복용제량화료정、합병용약정황이급림상기선특정등.본연구이PRU≤240위표준,장록필격뢰복용후혈소판반응성분위정상반응급저반응(즉록필격뢰저항),후자진일보근거기선활성급억제솔수평분위Ⅰ형(즉기선상관형,가성저항)、Ⅱ형(억제솔상관형,진성저항)화Ⅲ형(복합형)3충아형.결과 99례수검환자중록필격뢰저항자48례(48.5％),기중Ⅰ、Ⅱ화Ⅲ형저항분별위9례(9.1％)、27례(27.3％)화12례(12.1％)；여남성상비,녀성환자혈소판기선활성교고(P＜0.01),동시PRU증고적인군비례교고(P＜0.01),녀성위Ⅰ형저항적예측인소(OR=6.500, 95％ CI2.295 ～ 18.407,P＜0.01)；이체질지수(BMI) ＞24 kg/m2여록필격뢰혈소판억제솔현저상관(P＜0.05),제시위Ⅱ형저항적예측인소( OR=3.207,95％CI1.375 ～7.485,P＜0.01).년령、고혈압、당뇨병、흡연、고지혈증、C반응단백、합용반탁랍서등인소여기선활성급혈소판억제솔균무명현상관성.결론 VerfyNow-P2Y12계통검측제시,록필격뢰Ⅰ형저항인혈소판기선활성과고소치,녀성위고기선활성적독립예측인소；Ⅱ형저항인혈소판억제솔과저소치,여록필격뢰약리작용감약유관,초중위기영향인소；Ⅲ형저항동시존재고기선급저억제솔적특정；년령、고혈압、당뇨병、흡연、고지혈증、C반응단백급합용질자빙억제제반탁랍서등인소여록필격뢰저항적발생무명현상관성.
Objective To evaluate the platelet inhibition efficacy in patients under regular maintenance dose of clopidogrel by VerifyNow-P2Y12 assay and explore the clinical characteristics of clopidogrel non-responders and related predicting factors.Methods A total of 99 patients underwent percutaueous coronary intervention procedure and receiving clopidogrel in regular maintenance dose for at least 1 week were enrolled. Platelet reactivity,including baseline,P2Y12 reaction unit (PRU),and platelet inhibition rate were measured with VeifyNow-P2Y12 assay. The dosage of anti-platelet drugs,combination with any other drugs,clinical characters in baseline of all enrolled patients were analyzed.PRU ≤240 was used as cut-off to identify clopidogrel responder and clopidogrel non-responder.In the nonresponder group,patients were further separated into 3 sub-groups (types) according to the baseline and platelet inhibition rate:type Ⅰ with high baseline,high inhibition rate,representing false non-responder;type Ⅱ with low inhibition rate,representing true non-responder and type Ⅲ mixed type.Results In this study,48 of 99 patients were found to be clopidogrel non-responder (48.5％). The ratio of type Ⅰ,type Ⅱ and type Ⅲ in the non-responder group was 9.1％ ( n =9 ),27.3 ％ ( n =27 ),and 12.1％ ( n =12 ),respectively.Baseline platelet value in female patients was significantly higher than in males ( P ＜ 0.01 ),number of females with high PRU also is higher than males (P ＜ 0.01 ),female gender was a predict factor for type Ⅰ nnn-responder( OR =6.5,95％ CI 2.295 - 18.407,P ＜ 0.01 ). BMI ＞ 24 kg/m2 was a risk factor for clopidogrel non-responder ( P ＜ 0.05 ),and may be regarded as a predict factor for type Ⅱ nonresponder(OR =3.207,95％ CI 1.375 - 7.485,P ＜ 0.01 ). Age,hypertension,diabetics,smoking,hyperlipidemia,CRP and pantoprazole use do not show significant correlation with baseline and platelet inhibition rate.Conclusions Clopidogrel responses could be reliably detected by VerifyNow-P2Y12 assay.Female gender and high body weigbt are independent risk factors for clopidogrel non-responses.
