CAJ | 학술논문

目的：探讨在治疗氯吡格雷抵抗患者时，将氯吡格雷更换为替格瑞洛后血小板聚集率的变化情况。方法选择正在应用氯吡格雷75 mg/d治疗的经皮冠状动脉介入治疗（ PCI）术后患者512例，用比浊法测定血小板聚集率，根据血小板聚集率筛选出氯吡格雷抵抗患者88例。然后将这88例患者1：1随机分为氯吡格雷组及替格瑞洛组，氯吡格雷组继续服用氯吡格雷（75 mg/d），替格瑞洛组将氯吡格雷（75 mg/d）更换为替格瑞洛（90 mg，2次/d）。随访7d，主要观察7d前后血小板聚集率的变化，同时观察7d内出血发生率。结果治疗后替格瑞洛组较氯吡格雷组血小板聚集率低〔（43.3±8.2）%比（56.9±5.3）%〕，差异有统计学意义（P﹤0.05）；替格瑞洛组血小板聚集率下降值较氯吡格雷组大〔（16.4±9.8）%比（1.1±4.1）%〕，差异有统计学意义（ P﹤0.05）；替格瑞洛组血小板聚集率达标率较氯吡格雷组高（84.4%比4.7%），差异有统计学意义（ P﹤0.05）；替格瑞洛组及氯吡格雷组在试验过程中均无主要出血。结论对于氯吡格雷抵抗患者，将氯吡格雷更换为替格瑞洛后能明显降低血小板聚集率。
목적：탐토재치료록필격뢰저항환자시，장록필격뢰경환위체격서락후혈소판취집솔적변화정황。방법선택정재응용록필격뢰75 mg/d치료적경피관상동맥개입치료（ PCI）술후환자512례，용비탁법측정혈소판취집솔，근거혈소판취집솔사선출록필격뢰저항환자88례。연후장저88례환자1：1수궤분위록필격뢰조급체격서락조，록필격뢰조계속복용록필격뢰（75 mg/d），체격서락조장록필격뢰（75 mg/d）경환위체격서락（90 mg，2차/d）。수방7d，주요관찰7d전후혈소판취집솔적변화，동시관찰7d내출혈발생솔。결과치료후체격서락조교록필격뢰조혈소판취집솔저〔（43.3±8.2）%비（56.9±5.3）%〕，차이유통계학의의（P﹤0.05）；체격서락조혈소판취집솔하강치교록필격뢰조대〔（16.4±9.8）%비（1.1±4.1）%〕，차이유통계학의의（ P﹤0.05）；체격서락조혈소판취집솔체표솔교록필격뢰조고（84.4%비4.7%），차이유통계학의의（ P﹤0.05）；체격서락조급록필격뢰조재시험과정중균무주요출혈。결론대우록필격뢰저항환자，장록필격뢰경환위체격서락후능명현강저혈소판취집솔。
Objective To research the variance of the platelet aggregation ratio after using ticagrelor instead of clopi-dogrel in patients with clopidogrel resistance. Methods Adenosine diphosphate( ADP)induced platelet aggregation ratio test was run to identify patients with clopidogrel resistance in 512 patients undergoing the treatment of percutaneous coronary interven-tion( PCI)and clopidogrel 75 mg/d. 88 patients with clopidogrel resistance were given randomly clopidogrel 75 mg/d or ticagrelor (90 mg twice a day)for 7 days and took the test of the platelet aggregation ratio after the treatment. Results Aftertreatment for ti-cagrelor group compared with clopidogrel platelet aggregation rate low〔(43. 3 ± 8. 2)% vs. (56. 9 ± 5. 3)%〕,the difference was statistically significant ( P ﹤0. 05 );for the ticagrelor group, platelet aggregation rate decrease than clopidogrel group〔(16. 4 ±9. 8)% vs. (1. 1 ± 4. 1)%〕,the difference is statistically significant(P﹤0. 05);for the the ticagrelor group, platelet aggregation rate compliance rate than clopidogrel group was higher(84. 4% vs. 4. 7%),the difference was statistically significant(P﹤0. 05);for the ticagrelor group and clopidogrel group in the course of the experiment showed no major bleed-ing. Conclusion Ticagrelor,comparing the regular-dose treatment of clopidogrel,can decrease the platelet aggregation ratio in patients with clopidogrel resistance.