CAJ | 학술논문

目的观察冠心病患者氯吡格雷抵抗(CR)的发生率及其对临床预后的影响,并探讨血小板参数与CR的相关性.方法入选2007年7-12月北京大学第三医院心内科住院的152例冠心病患者,所有患者在给予氯吡格雷负荷剂量300 mg口服后改为维持剂量75 mg/d.在患者服药后第5～7天,采用全血电阻法(EIA)检测氯吡格雷对血小板聚集的抑制程度.血小板自发聚集(电阻≥10 Ω)定义为CR.根据检测结果将患者分为CR组和氯吡格雷敏感(CS)组,比较两组临床资料、血生化指标和血小板参数.对所有患者进行临床随访,记录患者心血管事件发生情况,包括再发心肌梗死、支架再狭窄、支架内血栓、再介入和心源性死亡.结果共有16例(10.5％)患者发生CR.CR组合并糖尿病患者的比例显著高于CS组(7/16比29/136,P=0.046).CR组血小板计数和平均血小板体积(MPV)显著高于CS组[(241±58)×109/L比(185士56)× 109/L,P=0.005;(8.0±0.8)fl比(7.4±0.9)fl,P=0.024].回归分析显示,血小板计数每增加10×109/L,患者发生CR的风险升高0.376倍(OR=1.376,95％ CI1.097～1.725,P=0.006)；MVP每增加1fl,患者发生CR的风险升高1.015倍(OR=2.015,95％ CI1.148 ～3.537,P=0.015).对所有患者平均临床随访53个月,结果显示CR组心血管事件发生率显著高于CS组(6/16比23/136,P=0.047).结论发生CR的冠心病患者心血管事件发生率高.而血小板计数和MPV升高与冠心病患者CR发生率相平行,可作为CR的有效预测因素.
목적 관찰관심병환자록필격뢰저항(CR)적발생솔급기대림상예후적영향,병탐토혈소판삼수여CR적상관성.방법 입선2007년7-12월북경대학제삼의원심내과주원적152례관심병환자,소유환자재급여록필격뢰부하제량300 mg구복후개위유지제량75 mg/d.재환자복약후제5～7천,채용전혈전조법(EIA)검측록필격뢰대혈소판취집적억제정도.혈소판자발취집(전조≥10 Ω)정의위CR.근거검측결과장환자분위CR조화록필격뢰민감(CS)조,비교량조림상자료、혈생화지표화혈소판삼수.대소유환자진행림상수방,기록환자심혈관사건발생정황,포괄재발심기경사、지가재협착、지가내혈전、재개입화심원성사망.결과 공유16례(10.5％)환자발생CR.CR조합병당뇨병환자적비례현저고우CS조(7/16비29/136,P=0.046).CR조혈소판계수화평균혈소판체적(MPV)현저고우CS조[(241±58)×109/L비(185사56)× 109/L,P=0.005;(8.0±0.8)fl비(7.4±0.9)fl,P=0.024].회귀분석현시,혈소판계수매증가10×109/L,환자발생CR적풍험승고0.376배(OR=1.376,95％ CI1.097～1.725,P=0.006)；MVP매증가1fl,환자발생CR적풍험승고1.015배(OR=2.015,95％ CI1.148 ～3.537,P=0.015).대소유환자평균림상수방53개월,결과현시CR조심혈관사건발생솔현저고우CS조(6/16비23/136,P=0.047).결론 발생CR적관심병환자심혈관사건발생솔고.이혈소판계수화MPV승고여관심병환자CR발생솔상평행,가작위CR적유효예측인소.
Objective To explore the association between clopidogrel resistance (CR) as assessed by whole blood electrical impedance aggregometry (EIA) and platelet parameters.Methods The prospective study comprised 152 patients with coronary artery disease (CAD) on the therapy of clopidogrel.EIA employed adenosine diphosphate (ADP) as an inductor to measure platelet aggregation.CR was defined by spontaneous aggregation (electrical impedance ≥ 10 Ω).The subjects were divided into 2 groups of CR and clopidogrel sensitive (CS).Platelet parameters were measured by routine blood test.And their clinical data and outcomes were analyzed.Results The prevalence of CR was 10.5％ (n =16).The ratio of patients with diabetes in CR group was higher than that in CS group (7/16 vs 29/136,P =0.046).Platelet counts and mean platelet volume (MPV) were also higher in CR group than those in CS group ((241 ± 58) ×109/Lvs (185 ±56) × 109/L,(8.0 ±0.8) fl vs (7.4 ±0.9) fl,both P ＜0.05).Logistic regression indicated each 10 × 109/L increase in platelet and each 1 fl increase in MVP were associated with 0.376 and 1.015 folds increase in CR onset respectively(OR =1.376,95％ CI 1.097-1.725,P =0.006 ;OR =2.015,95％ CI 1.148-3.537,P =0.015).The patients with CR had more cardiovascular events during an average follow-up of 53 months (6/16 vs 23/136,P =0.047).Conclusions CAD patients with CR had higher incidence of cardiovascular events.Increased platelet counts and MPV levels are independent predictors for CR in CAD patients.