CAJ | 학술논문

目的：探讨不同强化抗血小板治疗方案对急性冠状动脉综合征（ACS）经皮冠状动脉介入术（PCI）后患者氯吡格雷抵抗（CR）发生率及超敏 C-反应蛋白（hs-CRP）的影响。方法将125例确诊为ACS急诊行PCI术后的患者，随机分为三组，A组（n＝42）：口服阿司匹林100 mg Qd＋氯吡格雷75 mg Qd；B 组（n＝42）：口服阿司匹林100 mg Qd＋氯吡格雷75 mg Bid；C组（n＝41）：口服阿司匹林100 mg Qd＋氯吡格雷75 mg Qd＋西洛他唑50 mg Bid。利用全血电阻抗法检测治疗前、治疗第7天的血小板聚集率，酶联免疫吸附法测定PCI前、PCI术后24 h、PCI术后第7天的hs-CRP，计算并比较CR的发生率，观察住院期间主要不良心脏事件（MACE）发生率、出血并发症。结果 B组与C组的 CR发生率无显著差异（16.7%vs.14.6%），两组均明显低于A组（35.7%）（P＜0.05）；B组和C组PCI术后24 h、PCI术后第7天的hs-CRP水平无显著差异[（12.5±7.4）mg/L vs.（12.8±7.1）mg/L，（9.2±6.8）mg/L vs.（8.5±6.3） mg/L]，两组均明显低于A组[（16.7±6.3）mg /L，（11.8±5.4）mg /L，P＜0.05]；B组和C组MACE发生率明显低于A组[（2.4%，2.4%）vs.16.7%]（P＜0.05）；C组出血率明显高于A组和B组[14.6%vs.（2.4%，2.4%）]（P＜0.05）。结论两种强化抗血小板治疗方案均明显降低ACS急诊PCI术后患者CR发生率和hs-CRP水平，标准双联抗血小板联合西洛他唑方案的出血发生率明显低于阿司匹林联合双倍氯吡格雷方案。
목적：탐토불동강화항혈소판치료방안대급성관상동맥종합정（ACS）경피관상동맥개입술（PCI）후환자록필격뢰저항（CR）발생솔급초민 C-반응단백（hs-CRP）적영향。방법장125례학진위ACS급진행PCI술후적환자，수궤분위삼조，A조（n＝42）：구복아사필림100 mg Qd＋록필격뢰75 mg Qd；B 조（n＝42）：구복아사필림100 mg Qd＋록필격뢰75 mg Bid；C조（n＝41）：구복아사필림100 mg Qd＋록필격뢰75 mg Qd＋서락타서50 mg Bid。이용전혈전조항법검측치료전、치료제7천적혈소판취집솔，매련면역흡부법측정PCI전、PCI술후24 h、PCI술후제7천적hs-CRP，계산병비교CR적발생솔，관찰주원기간주요불양심장사건（MACE）발생솔、출혈병발증。결과 B조여C조적 CR발생솔무현저차이（16.7%vs.14.6%），량조균명현저우A조（35.7%）（P＜0.05）；B조화C조PCI술후24 h、PCI술후제7천적hs-CRP수평무현저차이[（12.5±7.4）mg/L vs.（12.8±7.1）mg/L，（9.2±6.8）mg/L vs.（8.5±6.3） mg/L]，량조균명현저우A조[（16.7±6.3）mg /L，（11.8±5.4）mg /L，P＜0.05]；B조화C조MACE발생솔명현저우A조[（2.4%，2.4%）vs.16.7%]（P＜0.05）；C조출혈솔명현고우A조화B조[14.6%vs.（2.4%，2.4%）]（P＜0.05）。결론량충강화항혈소판치료방안균명현강저ACS급진PCI술후환자CR발생솔화hs-CRP수평，표준쌍련항혈소판연합서락타서방안적출혈발생솔명현저우아사필림연합쌍배록필격뢰방안。
Objective To explore the effect of various intensive antiplatelet therapy on clopidogrel resistance(CR) incidence and high-sensitivity C-reactive protein(hs-CRP) for patients with acute coronary syndrome post percutaneous coronary intervention (PCI). Methods 125 patients diagnosed ACS after emergency PCI were randomly divided into three groups, group A (n=42) treated with dual antiplatelet regimen (aspirin 100 mg Qd plus clopidogrel 75 mg Qd);group B (n=42) treated with dual antiplatelet regimen (aspirin 100 mg Qd plus clopidogrel 75 mg Bid); group C (n=41) treated with triple antiplatelet regimen (aspirin 100 mg Qd plus clopidogrel 75 mg Qd plus cilostazol 50 mg Bid). Platelet aggregation was detected by whole blood electrical impedance assay before PCI and at the 7th day of treatment, and hs-CRP was detected by enzyme-linked immunosorbent assay before PCI,at 24 h and 7th day after PCI, clopidogrel resistance(CR) incidence was calculated and major adverse cardiac events (MACE) incidence and bleeding complications were observed in hospital. Results There were no significant difference in CR incidence between group B and group C(16.7%vs 14.6%), and both of them were significantly lower than group A(35.7%) (P<0.05);The level of hs-CRP between group B and group C at 24h and 7th day after PCI had no significant difference[(12.5±7.4)mg/L vs.(12.8±7.1)mg/L, (9.2±6.8)mg/L vs.(8.5±6.3)mg/L], but significantly lower than group A[(16.7±6.3)mg/L, (11.8±5.4)mg/L, P<0.05];MACE rate in group B and group C was significantly lower than group A[(2.4%, 2.4%) vs.16.7%(P<0.05)];Bleeding rate in group C was significantly higher than that in the other two group [14.6%vs.(2.4%, 2.4%) ](P<0.05) respectively. Conclusion Intensive anti-platelet treatment could significantly lower the incidence of CR and hs-CRP level in patients with ACS undergoing emergency PCI, but bleeding incidence in joint cilostazol program was significantly lower than double clopidogrel program.