CAJ | 학술논문

目的：研究急性冠脉综合征（ACS）患者冠状动脉介入术（PCI）后氯吡格雷体内代谢产物血药浓度与个体反应性差异及心血管事件的关系。方法选取明确诊断为冠心病并择期行PCI治疗的患者200例。根据血栓弹力图(TEG)检测结果，将二磷酸腺苷（ADP）途径抑制率＞80%为氯吡格雷反应优良组（n=105例），＜80%为氯吡格雷低反应组（n=95例），采用高效液相色谱串联质谱电喷雾检测法（HTLC-MS/MS）测定患者氯吡格雷、2-氧-氯吡格雷及羧酸代谢物的浓度。随访患者PCI术后1年时的心脏事件。结果低反应组氯吡格雷血浆浓度明显低于反应优良组，羧酸代谢物相对浓度方面略高于反应优良组（P均＜0.05）；两组在2-氧-氯吡格雷血药相对浓度差异无统计学意义（P＞0.05）。低反应组再发心绞痛及出血事件发生率高于反应优良组（P＜0.05）。结论氯吡格雷代谢物血药浓度水平影响个体氯吡格雷反应性，氯吡格雷反应不良的发生增加了临床心血管事件的风险。
목적：연구급성관맥종합정（ACS）환자관상동맥개입술（PCI）후록필격뢰체내대사산물혈약농도여개체반응성차이급심혈관사건적관계。방법선취명학진단위관심병병택기행PCI치료적환자200례。근거혈전탄력도(TEG)검측결과，장이린산선감（ADP）도경억제솔＞80%위록필격뢰반응우량조（n=105례），＜80%위록필격뢰저반응조（n=95례），채용고효액상색보천련질보전분무검측법（HTLC-MS/MS）측정환자록필격뢰、2-양-록필격뢰급최산대사물적농도。수방환자PCI술후1년시적심장사건。결과저반응조록필격뢰혈장농도명현저우반응우량조，최산대사물상대농도방면략고우반응우량조（P균＜0.05）；량조재2-양-록필격뢰혈약상대농도차이무통계학의의（P＞0.05）。저반응조재발심교통급출혈사건발생솔고우반응우량조（P＜0.05）。결론록필격뢰대사물혈약농도수평영향개체록필격뢰반응성，록필격뢰반응불량적발생증가료림상심혈관사건적풍험。
Objective To study the relationship between plasma concentration of clopidogrel and difference of individual response or major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) after PCI. Methods The patients (n=200) diagnosed as CHD and having selected PCI were chosen and divided into high-reaction clopidogrel group (ADP inhibitory rate>80%, n=105) and low-reaction clopidogrel group (ADP inhibitory rate<80%, n=95) according to the outcomes of thrombelastogram (TEG). The plasma concentration of clopidogrel, 2-oxo-clopidogrel and carboxylic acid metabolites were detected by using high-throughput liquid chromatography-mass spectrometric (HTLC-MS/MS). The incidence of MACE was followed up after PCI for one year. Results The plasma concentration of clopidogrel was significantly lower, and that of carboxylic acid metabolites was slightly higher in low-reaction clopidogrel group than those in high-reaction clopidogrel group (all P<0.05). The difference in plasma concentration of 2-oxo-clopidogrel had no statistical significance between two groups (P>0.05). The incidences of relapsed angina and bleeding events were higher in low-reaction clopidogrel group than those in high-reaction clopidogrel group (P<0.05). Conclusion The plasma concentration of clopidogrel effects on individual response, and low reaction to clopidogrel will increase the risk of MACE in clinic.