药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2014年
1期
10-14
,共5页
柳亚敏%邵华%厉伟兰%智宏%罗璨
柳亞敏%邵華%厲偉蘭%智宏%囉璨
류아민%소화%려위란%지굉%라찬
氯吡格雷%急性冠状动脉综合征%再发心血管事件
氯吡格雷%急性冠狀動脈綜閤徵%再髮心血管事件
록필격뢰%급성관상동맥종합정%재발심혈관사건
Clopidogrel%Acute coronary syndrome%Recurrent cardiovascular events
目的 探讨急性冠状动脉综合征(ACS)患者对氯吡格雷的反应变异性与再发心血管事件的关系. 方法 ACS患者入院第1天或经皮冠状动脉介入术前服用负荷剂量氯吡格雷(300 mg/d),第2天起服用维持剂量(75 mg/d),同时口服阿司匹林(100 mg/d),共服用1年.检测患者服用负荷剂量氯吡格雷前和服用后24 h最大血小板聚集率(MAR)并计算血小板聚集抑制率(IPA).根据IPA将患者分为对氯吡格雷无反应组、低反应组和反应组.分别在服药第1、3、6、12个月末进行随访,记录患者出现再发心血管事件(包括心血管死亡、急性和亚急性支架血栓、再发ACS和缺血性中风)的情况.用Kaplan-Meier生存分析法比较3组患者再发心血管事件的累积发生率.结果 2009年10月至2013年3月在东南大学附属中大医院心内科住院的190例ACS患者纳入研究,男性111例,女性79例,平均年龄(66.1±7.8)岁.氯吡格雷无反应组53例、低反应组46例、反应组91例.3组患者性别构成、合并危险因素及合并用药的差异均无统计学意义(均P＞0.05),氯吡格雷无反应组平均年龄[(69.1±7.8)岁]大于反应组[(64.3±7.4)岁](P＜0.05),无反应组1、3、6、12个月再发心血管事件累积发生率[11.3％(6/53)、20.8％(11/53)、22.6％(12/53)、35.8％(19/53)]均明显高于反应组[1.1％ (1/91)、1.1％(1/91)、2.2％(2/91)、9.9％ (9/91)](均P＜0.05).Kaplan-Meier生存分析显示氯吡格雷无反应组再发心血管事件累积发生率明显高于低反应组(P＜0.05)与反应组(P＜0.01). 结论 ACS患者对氯吡格雷反应的变异性与再发心血管事件可能有关.对使用氯吡格雷的患者应检测MAR与IPA,以减少或避免发生再发心血管事件.
目的 探討急性冠狀動脈綜閤徵(ACS)患者對氯吡格雷的反應變異性與再髮心血管事件的關繫. 方法 ACS患者入院第1天或經皮冠狀動脈介入術前服用負荷劑量氯吡格雷(300 mg/d),第2天起服用維持劑量(75 mg/d),同時口服阿司匹林(100 mg/d),共服用1年.檢測患者服用負荷劑量氯吡格雷前和服用後24 h最大血小闆聚集率(MAR)併計算血小闆聚集抑製率(IPA).根據IPA將患者分為對氯吡格雷無反應組、低反應組和反應組.分彆在服藥第1、3、6、12箇月末進行隨訪,記錄患者齣現再髮心血管事件(包括心血管死亡、急性和亞急性支架血栓、再髮ACS和缺血性中風)的情況.用Kaplan-Meier生存分析法比較3組患者再髮心血管事件的纍積髮生率.結果 2009年10月至2013年3月在東南大學附屬中大醫院心內科住院的190例ACS患者納入研究,男性111例,女性79例,平均年齡(66.1±7.8)歲.氯吡格雷無反應組53例、低反應組46例、反應組91例.3組患者性彆構成、閤併危險因素及閤併用藥的差異均無統計學意義(均P＞0.05),氯吡格雷無反應組平均年齡[(69.1±7.8)歲]大于反應組[(64.3±7.4)歲](P＜0.05),無反應組1、3、6、12箇月再髮心血管事件纍積髮生率[11.3％(6/53)、20.8％(11/53)、22.6％(12/53)、35.8％(19/53)]均明顯高于反應組[1.1％ (1/91)、1.1％(1/91)、2.2％(2/91)、9.9％ (9/91)](均P＜0.05).Kaplan-Meier生存分析顯示氯吡格雷無反應組再髮心血管事件纍積髮生率明顯高于低反應組(P＜0.05)與反應組(P＜0.01). 結論 ACS患者對氯吡格雷反應的變異性與再髮心血管事件可能有關.對使用氯吡格雷的患者應檢測MAR與IPA,以減少或避免髮生再髮心血管事件.
목적 탐토급성관상동맥종합정(ACS)환자대록필격뢰적반응변이성여재발심혈관사건적관계. 방법 ACS환자입원제1천혹경피관상동맥개입술전복용부하제량록필격뢰(300 mg/d),제2천기복용유지제량(75 mg/d),동시구복아사필림(100 mg/d),공복용1년.검측환자복용부하제량록필격뢰전화복용후24 h최대혈소판취집솔(MAR)병계산혈소판취집억제솔(IPA).근거IPA장환자분위대록필격뢰무반응조、저반응조화반응조.분별재복약제1、3、6、12개월말진행수방,기록환자출현재발심혈관사건(포괄심혈관사망、급성화아급성지가혈전、재발ACS화결혈성중풍)적정황.용Kaplan-Meier생존분석법비교3조환자재발심혈관사건적루적발생솔.결과 2009년10월지2013년3월재동남대학부속중대의원심내과주원적190례ACS환자납입연구,남성111례,녀성79례,평균년령(66.1±7.8)세.록필격뢰무반응조53례、저반응조46례、반응조91례.3조환자성별구성、합병위험인소급합병용약적차이균무통계학의의(균P＞0.05),록필격뢰무반응조평균년령[(69.1±7.8)세]대우반응조[(64.3±7.4)세](P＜0.05),무반응조1、3、6、12개월재발심혈관사건루적발생솔[11.3％(6/53)、20.8％(11/53)、22.6％(12/53)、35.8％(19/53)]균명현고우반응조[1.1％ (1/91)、1.1％(1/91)、2.2％(2/91)、9.9％ (9/91)](균P＜0.05).Kaplan-Meier생존분석현시록필격뢰무반응조재발심혈관사건루적발생솔명현고우저반응조(P＜0.05)여반응조(P＜0.01). 결론 ACS환자대록필격뢰반응적변이성여재발심혈관사건가능유관.대사용록필격뢰적환자응검측MAR여IPA,이감소혹피면발생재발심혈관사건.
Objective To explore the relationship between the response variability in patients with acute coronary syndrome (ACS) treated with clopidogrel and the recurrent cardiovascular events.Methods The ACS patients received loading dose of clopidogrel (300 mg/d) on the first day of hospitalization or before percutaneous coronary intervention,then received maintenance dose of clopidogrel (75 mg/d) from the second day,in addition,all patients received aspirin (100 mg/d) for one year.The patients' maximal aggregation rate (MAR) and inhibition of platelet aggregation(IPA) were measured before and 24 hours after administration of loading dose of clopidogrel.The patients were divided into non-response to clopidogrel,low-response to clopidogrel,and response to clopidogrel groups according to the IPA.The patients were followed-up at the end of 1,3,6,and 12 months after administration,respectively.The situation of recurrent cardiovascular (CV) events including cardiovascular death,acute and subacute stent thromboses,recurrent acute coronary artery syndrome,and ischemic stroke were recorded.The differences in accumulative incidence of recurrent CV events among the 3 groups were compared by Kaplan-Meier survival analysis.Results A total of 190 patients with ACS who were hospitalized in the Department of Cardiology,Zhongda Hospital,Southeast University from October 2009 to March 2013 were enrolled into the study,comprising 111 males and 79 females with an average age of (66.1 ± 7.8) years.There were 53,46,and 91 patients in the non-response to clopidogrel group,the low-response to clopidogrel group,and the response to clopidogrel group,respectively.The differences in the sex composition,combined risk factors,and drug combination among the 3 groups were not significant (all P ＞ 0.05).The average age in the nonresponse to clopidogrel group [(69.1 ±7.8) years] was older than that in the response to clopidogrel group [(64.3 ± 7.4) years] (P ＜ 0.05).The accumulative incidence of recurrent CV events on 1,3,6,and 12months in the non-response to clopidogrel group [11.3％ (6/53) 、20.8％ (11/53) 、22.6％ (12/53) and35.8％ (19/53) were significantly higher than those in the response to clopidogrel group [1.1％ (1/91)、1.1％ (1/91) 、2.2％ (2/91) and 9.9％ (9/91)] (all P ＜ 0.05).The results of Kaplan-Meier survival analysis showed that the accumulative incidence of recurrent CV events in the non-response to clopidogrel group were significantly higher than those in the low-response to clopidogrel group (P ＜ 0.05) and the response to clopidogrel group (P ＜ 0.01).Conclusions The response variability to clopidogrel of patient with ACS may be associated with recurrent CV events.The patient who received clopidogrel should be given the examination of MAR and IPA in order to decrease or avoid the recurrent CV events.
