CAJ | 학술논문

[目的]通过血栓弹力图(TEG)分析仪检测血小板聚集率,观察接受标准双联抗血小板治疗的住院老年急性冠脉综合征(ACS)患者的氯吡格雷抵抗发生率及可能的影响因素.[方法]选取109例老年(年龄≥60岁)ACS 患者,在常规服用阿司匹林100 mg/d 基础上,口服氯吡格雷75 mg/d ,5 d 以后采血,通过 TEG方法测定患者服用氯吡格雷和阿司匹林的血小板聚集率.以二磷酸腺苷诱导的血小板聚集率≥70%为氯吡格雷抵抗,花生四烯酸诱导的血小板聚集率>50%为阿司匹林抵抗.[结果]氯吡格雷抵抗发生率为31.2%(34例),有10.1%(11例)发生阿司匹林和氯吡格雷双抵抗.氯吡格雷抵抗组与非抵抗组间阿司匹林抵抗的发生率有非常显著的统计学意义( P < 0.01).两组患者在年龄、高血压、糖尿病、应用药物等方面差异无统计学意义( P > 0.05);但氯吡格雷抵抗组中无吸烟史的患者更多,差异具有统计学意义( P = 0.045);此外还观察到女性( P = 0.052)患者有容易发生氯吡格雷抵抗的趋势.[结论]接受标准抗血小板治疗的老年 ACS患者中,31.2%存在氯吡格雷抵抗现象.这一现象不受年龄、合并疾病、服用药物等影响,而阿司匹林抵抗或从未吸烟的患者更易发生氯吡格雷抵抗.
[목적]통과혈전탄력도(TEG)분석의검측혈소판취집솔,관찰접수표준쌍련항혈소판치료적주원노년급성관맥종합정(ACS)환자적록필격뢰저항발생솔급가능적영향인소.[방법]선취109례노년(년령≥60세)ACS 환자,재상규복용아사필림100 mg/d 기출상,구복록필격뢰75 mg/d ,5 d 이후채혈,통과 TEG방법측정환자복용록필격뢰화아사필림적혈소판취집솔.이이린산선감유도적혈소판취집솔≥70%위록필격뢰저항,화생사희산유도적혈소판취집솔>50%위아사필림저항.[결과]록필격뢰저항발생솔위31.2%(34례),유10.1%(11례)발생아사필림화록필격뢰쌍저항.록필격뢰저항조여비저항조간아사필림저항적발생솔유비상현저적통계학의의( P < 0.01).량조환자재년령、고혈압、당뇨병、응용약물등방면차이무통계학의의( P > 0.05);단록필격뢰저항조중무흡연사적환자경다,차이구유통계학의의( P = 0.045);차외환관찰도녀성( P = 0.052)환자유용역발생록필격뢰저항적추세.[결론]접수표준항혈소판치료적노년 ACS환자중,31.2%존재록필격뢰저항현상.저일현상불수년령、합병질병、복용약물등영향,이아사필림저항혹종미흡연적환자경역발생록필격뢰저항.
Objective] To measure the platelet aggregation by using thromboelastograph (TEG) ,and to observe the incidence and possible influential factors of clopidogrel resistance in elderly hospitalized patients with acute coronary syndrome (ACS) receiving standard dual antiplatelet therapy .[Methods]A total of 109 elderly ACS patients were chosen .Based on the routine oral aspirin 100mg/d ,all patients were given oral clo‐pidogrel 75mg/d .At 5th day ,blood sample was collected .TEG was used to measure platelet aggregation in patients taking clopidogrel and aspirin .Clopidogrel resistance was defined as adenosine diphosphate (ADP)‐in‐duced aggregation ≥ 70% ,and aspirin resistance was defined as arachidonic acid (AA )‐induced aggregation >50% .[Results] The incidence of clopidogrel resistance was 31 .2 (34/109) ,and the incidence of both clopi‐dogrel and aspirin resistance was 10 .1% (11/109) .There was significant difference in the incidence of aspirin resistance between clopidogrel resistance group and non‐resistance group( P < 0 .01) ,while there was no sig‐nificant difference in age ,hypertension ,diabetes mellitus and medicine between 2 groups( P > 0 .05) .In clopi‐dogrel resistance group ,most patients had no history of smoking ,and there was significant difference( P =0 .045) .Moreover ,the results showed that female patients seems to be easy to have clopidogrel resistance ( P= 0 .052) .[Conclusion] Clopidogrel resistant appears in 31 .2% in elderly patients with ACS receiving stand‐ard dual antiplatelet therapy .Clopidogrel resistance is not influenced by age ,concomitant disease and medi‐cine ,but patients with aspirin resistance or without smoking are easy to have clopidogrel resistance .