CAJ | 학술논문

目的评估抗血小板药物抵抗对再发心脏缺血事件的预测价值.方法用全血电阻法(EIA)检测急性心肌梗死(AMI)患者109例,观察阿司匹林和氯吡格雷对AMI患者血小板聚集的抑制程度,分为单纯阿司匹林抵抗组(AR)、单纯氯吡格雷抵抗组(CR)、双抵抗组(DR)和双敏感组(DS).随访记录再发心脏缺血事件.结果 AR组16例,CR组10例,DR组4例,DS组79例.AR组血小板计数和血糖高于DS组[(221 ±52)×109/L比(201 ±35)×109/L; (6.8±2.6)mmol/L比(5.8±1.9) mmol/L,P＜0.05];AR、CR和DR组心脏缺血事件显著高于DS组(12.5％,10.0％,50.0％比3.8％,P=0.036),其中支架内血栓发生率为6.3％,10.0％,50.0％比1.3％,(P=0.000).多因素分析示双抵抗是AMI患者支架术后1年心脏缺血事件和支架内血栓的独立预测因素(OR5.99,95％ CI 1.05 ～ 34.34,P=0.045;OR 6.36,95％ CI 1.13 ～35.78;P =0.036).结论抗血小板药物抵抗与AMI患者临床预后密切相关,阿司匹林联合氯吡格雷抵抗是再发心脏缺血事件的独立预测因素.
목적 평고항혈소판약물저항대재발심장결혈사건적예측개치.방법 용전혈전조법(EIA)검측급성심기경사(AMI)환자109례,관찰아사필림화록필격뢰대AMI환자혈소판취집적억제정도,분위단순아사필림저항조(AR)、단순록필격뢰저항조(CR)、쌍저항조(DR)화쌍민감조(DS).수방기록재발심장결혈사건.결과 AR조16례,CR조10례,DR조4례,DS조79례.AR조혈소판계수화혈당고우DS조[(221 ±52)×109/L비(201 ±35)×109/L; (6.8±2.6)mmol/L비(5.8±1.9) mmol/L,P＜0.05];AR、CR화DR조심장결혈사건현저고우DS조(12.5％,10.0％,50.0％비3.8％,P=0.036),기중지가내혈전발생솔위6.3％,10.0％,50.0％비1.3％,(P=0.000).다인소분석시쌍저항시AMI환자지가술후1년심장결혈사건화지가내혈전적독립예측인소(OR5.99,95％ CI 1.05 ～ 34.34,P=0.045;OR 6.36,95％ CI 1.13 ～35.78;P =0.036).결론 항혈소판약물저항여AMI환자림상예후밀절상관,아사필림연합록필격뢰저항시재발심장결혈사건적독립예측인소.
Objective To evaluate the predictive value of antiplatelet resistance assessed by whole blood electronic impedance aggregometry (EIA) for the risk of recurrent cardiac ischemic events in patients with acute myocardial infarction (AMI) who underwent coronary stenting.Methods We enrolled 109 patients with AMI,72 (66.1％ ) men and 37(33.9％ ) women with mean age (63 ± 12 )years,who were treated with aspirin and clopidogrel daily after coronary stenting.EIA used arachidonic acid ( AA ) and adenosine diphosphate (ADP) as inductors to measure platelet aggregation inhibited by aspirin and clopidogrel respectively.The subjects were divided into four groups:pure aspirin resistant group (AR,electrical impedance ＞ 0 Ω),pure clopidogrel resistant group ( CR,electrical impedance ≥ 10 Ω),dual resistant group (DR) and dual sensitive group (DS).The primary outcomes were recurrent cardiac ischemic events during the 12-month follow-up.Results Antiplatelet resistance occurred more often in patients with type 2 diabetes (P =0.027 ).The platelet counts (PLT) were higher in antiplatelet resistant groups than DSgroup (P =0.013 ).During the 12-month follow-up,the antiplatelet resistant patients had a higher incidence of recurrent cardiac ischemic events and stent thrombosis (ST) than the patients without (12.5％,10.0％,50.0％ vs 3.8％,P=0.036; 6.3％,10.0％,50.0％ vs 1.3％,P=0.000; respectively).Binary Logistic regression indicated that dual resistance remained an independent predicator of recurrence cardiac ischemic events and ST ( OR 5.99,95％ CI 1.05-34.34,P =0.045 ; OR 6.36,95％ CI 1.13-35.78,P =0.036 ; respectively).Conclusions As a physiological assessment of platelet reactivity,EIA is a convenient and accurate option for measuring aspirin resistance.Antiplatelet resistance assessed by EIA is paralleled to clinical events.Dual resistance is an independent predicator for ST and recurrence cardiac ischemic events in patients with AMI.