CAJ | 학술논문

目的观察体重≤65 kg的冠状动脉粥样硬化心脏病（冠心病）患者在常规联合应用阿司匹林100 mg/d基础上，于植入雷帕霉素药物洗脱支架术后90天起氯吡格雷由75 mg/d减量为50 mg/d双重抗血小板的个体化治疗方案的疗效的安全性与经济性。方法连续入选自2008年9月至2011年10月间在我院初次接受经皮腔内冠状动脉介入治疗的患者69例，符合下列条件者入选：体重≤65 kg，冠状动脉造影显示为单支或双支简单血管病变，每处病变植入1枚雷帕霉素药物洗脱支架（长度＜20 mm），血管直径≥3.0 mm。将患者随机分为氯吡格雷50 mg组（n＝34）和氯吡格雷75 mg组（n＝35）。出院及定期门诊随访时强化健康教育，以提高患者的依从性。随访1年，比较两组患者的血小板聚集率、死亡、非致死性心肌梗死、支架内血栓、靶血管重建、脑卒中、任何原因心肌缺血发作的再入院率，以及出血等药物安全性的差异，费用的差异。结果两组患者基线水平特征无明显差异。50 mg组和75 mg组在术后3个月、6个月、9个月及1年随访时血小板聚集率无明显差异，两组均未发生心肌缺血、非致死性心肌梗死、心血管原因的死亡。75 mg组有两例患者在6个月随访时因出现皮下瘀斑而转入50 mg组。50 mg组每例患者在随后的9个月费用相对于75 mg组可节省2967元（P＜0.05）。结论体重≤65 kg简单血管病变的冠心病患者植入DES支架术3个月后，氯吡格雷50 mg组与75 mg组相比，1年期间心脏缺血不良事件发生率无统计学差异，但出血风险更小，每例患者9个月时间还可节省2967元。
목적관찰체중≤65 kg적관상동맥죽양경화심장병（관심병）환자재상규연합응용아사필림100 mg/d기출상，우식입뢰파매소약물세탈지가술후90천기록필격뢰유75 mg/d감량위50 mg/d쌍중항혈소판적개체화치료방안적료효적안전성여경제성。방법련속입선자2008년9월지2011년10월간재아원초차접수경피강내관상동맥개입치료적환자69례，부합하렬조건자입선：체중≤65 kg，관상동맥조영현시위단지혹쌍지간단혈관병변，매처병변식입1매뢰파매소약물세탈지가（장도＜20 mm），혈관직경≥3.0 mm。장환자수궤분위록필격뢰50 mg조（n＝34）화록필격뢰75 mg조（n＝35）。출원급정기문진수방시강화건강교육，이제고환자적의종성。수방1년，비교량조환자적혈소판취집솔、사망、비치사성심기경사、지가내혈전、파혈관중건、뇌졸중、임하원인심기결혈발작적재입원솔，이급출혈등약물안전성적차이，비용적차이。결과량조환자기선수평특정무명현차이。50 mg조화75 mg조재술후3개월、6개월、9개월급1년수방시혈소판취집솔무명현차이，량조균미발생심기결혈、비치사성심기경사、심혈관원인적사망。75 mg조유량례환자재6개월수방시인출현피하어반이전입50 mg조。50 mg조매례환자재수후적9개월비용상대우75 mg조가절성2967원（P＜0.05）。결론체중≤65 kg간단혈관병변적관심병환자식입DES지가술3개월후，록필격뢰50 mg조여75 mg조상비，1년기간심장결혈불량사건발생솔무통계학차이，단출혈풍험경소，매례환자9개월시간환가절성2967원。
Objective To investigate the efficacy and safety profile of a low clopidogrel maintenance dose after implanting drug eluting stent 90 days in patients (weights≤65 kg) with simple coronary lesions. Methods From September 2008 to October 2011, a total of 69 patients (body weights≤65 kg) with simple coronary lesions (stent length < 20 mm and artery diameter ≥ 3.0 mm), underwent primary percutaneous coronary intervention in our hospital were entrolled consecutively. They were randomized into clopidogrel 50 mg group (n=34) and 75 mg group(n=35) in 91 days. All patients were followed for 12 months. The primary end points of the study were composite of platelete aggregation rate, death from the cardiovascular causes, non-fatal myocardial infarction, revascularization, stroke, as well as re-hospitalization for cardiac reason. The safety proifle including bleeding and drug costs were analyzed. Results Baseline characteristics were similar among the two groups. After one year of clinical follow-up, the 3 rd, 6 th, 9 th and 12 th month of platelete aggregation rates were similar among the two groups. Major adverse cardiac events were not found in the two groups. Two patients in the 75 mg group were tranferred into the 50 mg group, dued to their bruise. Drug cost of the 50 mg group was saved 2967 RMB compared with the 75 mg group in 9 months (P<0.05). Conclusion Major adverse cardiac events in the 50 mg group (patients who weighed≤65 kg) with simple coronary lesions were not different from the 75 mg group in the 1-year follow-up. But the bleeding risk was little, 2967 RMB were saved in 9-month for each patients in the 50 mg goup.