中国医药
中國醫藥
중국의약
CHINA MEDICINE
2013年
5期
605-607
,共3页
急性心肌梗死%氯吡格雷抵抗%直接经皮冠状动脉介入%无复流
急性心肌梗死%氯吡格雷牴抗%直接經皮冠狀動脈介入%無複流
급성심기경사%록필격뢰저항%직접경피관상동맥개입%무복류
Acute myocardial infarction%Clopidogrel resistance%Primary percutaneous coronary intervention%No-reflow
目的 观察氯吡格雷抵抗与急性心肌梗死(AMI)患者直接经皮冠状动脉介入(PPCI)术中无复流的关系.方法 入选2009年1月至2010年12月因AMI住院行PPCI术患者共765例,所有患者术后5d晨起空腹采血,根据对二磷酸腺苷诱导的血小板聚集抑制率判定是否出现氯吡格雷抵抗.根据术中是否出现无复流分为无复流组(81例)和对照组(684例),比较2组临床特点,分析氯吡格雷抵抗与术中出现无复流的关系.结果 2组男性比、高血压患病率、吸烟情况、发病至就诊时间、白细胞计数、血小板计数、梗死相关动脉、支架直径、门-球时间差异无统计学意义(P＞0.05).与对照组比较,无复流组糖尿病患病率[(29.6％ (24/81)比19.9％ (136/684),P=0.044]、年龄[(62±10)岁比(60±11)岁,P=0.032]、氯吡格雷抵抗发生率[38.3％(31/81)比24.9％ (170/684),P=0.011]、术前心肌梗死溶栓试验血流0级[82.7％(67/81)比70.5％ (482/684),P=0.026]、应用替罗非班者占比[42.0％ (34/81)比30.8％ (211/684),P=0.045]、肌钙蛋白Ⅰ(cTn Ⅰ)峰值[(58±14) μg/L比(54±13) μg/L,P=0.015]、肌酸激酶同工酶(CK-MB)峰值[(156±42) U/L比(145±40) U/L,P=0.027]、肌酸激酶(CK)峰值(1437±202) U/L比(1388±216)U/L,P=0.041]、病死率[4.9％ (4/81)比1.0％ (7/684),P=0.022]明显升高,ST段回落率[66.7％ (54/81)比82.5％ (564/684),P=0.001]及左心室射血分数(LVEF)[(48±11)％比(51±11)％,P=0.028]则明显下降.Logistic回归分析结果显示,在校正了其他危险因素之后,氯吡格雷抵抗是PPCI术中出现无复流的独立影响因素(比值比=3.466,95％置信区间:1.447～10.876,P=0.019).结论 氯吡格雷抵抗是PPCI术中出现无复流的可能机制之一,严重影响预后.
目的 觀察氯吡格雷牴抗與急性心肌梗死(AMI)患者直接經皮冠狀動脈介入(PPCI)術中無複流的關繫.方法 入選2009年1月至2010年12月因AMI住院行PPCI術患者共765例,所有患者術後5d晨起空腹採血,根據對二燐痠腺苷誘導的血小闆聚集抑製率判定是否齣現氯吡格雷牴抗.根據術中是否齣現無複流分為無複流組(81例)和對照組(684例),比較2組臨床特點,分析氯吡格雷牴抗與術中齣現無複流的關繫.結果 2組男性比、高血壓患病率、吸煙情況、髮病至就診時間、白細胞計數、血小闆計數、梗死相關動脈、支架直徑、門-毬時間差異無統計學意義(P＞0.05).與對照組比較,無複流組糖尿病患病率[(29.6％ (24/81)比19.9％ (136/684),P=0.044]、年齡[(62±10)歲比(60±11)歲,P=0.032]、氯吡格雷牴抗髮生率[38.3％(31/81)比24.9％ (170/684),P=0.011]、術前心肌梗死溶栓試驗血流0級[82.7％(67/81)比70.5％ (482/684),P=0.026]、應用替囉非班者佔比[42.0％ (34/81)比30.8％ (211/684),P=0.045]、肌鈣蛋白Ⅰ(cTn Ⅰ)峰值[(58±14) μg/L比(54±13) μg/L,P=0.015]、肌痠激酶同工酶(CK-MB)峰值[(156±42) U/L比(145±40) U/L,P=0.027]、肌痠激酶(CK)峰值(1437±202) U/L比(1388±216)U/L,P=0.041]、病死率[4.9％ (4/81)比1.0％ (7/684),P=0.022]明顯升高,ST段迴落率[66.7％ (54/81)比82.5％ (564/684),P=0.001]及左心室射血分數(LVEF)[(48±11)％比(51±11)％,P=0.028]則明顯下降.Logistic迴歸分析結果顯示,在校正瞭其他危險因素之後,氯吡格雷牴抗是PPCI術中齣現無複流的獨立影響因素(比值比=3.466,95％置信區間:1.447～10.876,P=0.019).結論 氯吡格雷牴抗是PPCI術中齣現無複流的可能機製之一,嚴重影響預後.
목적 관찰록필격뢰저항여급성심기경사(AMI)환자직접경피관상동맥개입(PPCI)술중무복류적관계.방법 입선2009년1월지2010년12월인AMI주원행PPCI술환자공765례,소유환자술후5d신기공복채혈,근거대이린산선감유도적혈소판취집억제솔판정시부출현록필격뢰저항.근거술중시부출현무복류분위무복류조(81례)화대조조(684례),비교2조림상특점,분석록필격뢰저항여술중출현무복류적관계.결과 2조남성비、고혈압환병솔、흡연정황、발병지취진시간、백세포계수、혈소판계수、경사상관동맥、지가직경、문-구시간차이무통계학의의(P＞0.05).여대조조비교,무복류조당뇨병환병솔[(29.6％ (24/81)비19.9％ (136/684),P=0.044]、년령[(62±10)세비(60±11)세,P=0.032]、록필격뢰저항발생솔[38.3％(31/81)비24.9％ (170/684),P=0.011]、술전심기경사용전시험혈류0급[82.7％(67/81)비70.5％ (482/684),P=0.026]、응용체라비반자점비[42.0％ (34/81)비30.8％ (211/684),P=0.045]、기개단백Ⅰ(cTn Ⅰ)봉치[(58±14) μg/L비(54±13) μg/L,P=0.015]、기산격매동공매(CK-MB)봉치[(156±42) U/L비(145±40) U/L,P=0.027]、기산격매(CK)봉치(1437±202) U/L비(1388±216)U/L,P=0.041]、병사솔[4.9％ (4/81)비1.0％ (7/684),P=0.022]명현승고,ST단회락솔[66.7％ (54/81)비82.5％ (564/684),P=0.001]급좌심실사혈분수(LVEF)[(48±11)％비(51±11)％,P=0.028]칙명현하강.Logistic회귀분석결과현시,재교정료기타위험인소지후,록필격뢰저항시PPCI술중출현무복류적독립영향인소(비치비=3.466,95％치신구간:1.447～10.876,P=0.019).결론 록필격뢰저항시PPCI술중출현무복류적가능궤제지일,엄중영향예후.
Objective To evaluate clopidogrel resistance in patients who underwent primary percutaneous coronary intervention (PPCI) and the relationship with the no-reflow phenomenon.Methods From January 2009 to December 2011,765 acute myocardial infarction patients undergoing PPCI were enrolled in this study.Clopidogrel resistance defined according to ADP induced maximal platelet aggregation rate; the patients were divided into no reflow group and control group.The clinical data were compared to analyze the clopidogrel resistance contributing to no reflow.Results Male,the history of hypertension,smoking,time to admission,the count of platelet and white blood cell,IRA,stent diameter and door-balloon time showed no differences between two groups.Compared with the control group,age(62 ± 10 vs 60 ± 11,P =0.032),diabetes mellitus [29.6％ (24/81) vs 19.9％ (136/684),P =0.044],the occurrence of clopidogrel resistance[38.3％ (31/81) vs 24.9％ (170/684),P =0.011],thrombolysis in myocardial infarction flow grade 0 pre-procedure [82.7 ％ (67/81) vs 70.5 ％ (482/684),P =0.026],using of tirofiban [42.0％ (34/81) vs 30.8 ％ (211/684),P =0.045],the peak of cardial troponin Ⅰ [(58 ± 14)μg/L vs (54±13) μg/L,P=0.015],creatine kinase isoenzyme [(156 ±42)U/L vs (145 ±40) U/L,P=0.027] and creatine kinase [(1437 ±202) U/L vs(1388 ±216) U/L,P =0.041] and mortality[4.9％ (4/81)vs 1.0 ％ (7/684),P =0.022] were increased significantly; the incidence of ST resolution [66.7％ (54/81) vs 82.5％(564/684),P=0.001] and left ejection fraction [(48 ±11)％ vs (51 ±11)％,P=0.028]were decreased in no-roflow group.Logistic analysis showed that clopidogrel resistance was an independent factor of no-reflow during PPCI.Conclusion Clopidogrel resistance may be one of the responsible mechanisms for the no-reflow phenomenon.
