CAJ | 학술논문

目的观察PCI患者氯吡格雷骤停或逐渐减停后血小板CD62P、CD63水平的变化。方法冠状动脉药物洗脱支架（DES）植入术后服用阿司匹林、氯吡格雷双重抗血小板治疗12个月以上者共64例入组，其中对照组32例入选后即停服氯吡格雷；观察组32例隔天服氯吡格雷4周后完全停药。分别于入组时（0周）及入组后1、2、4、12周测定血小板溶酶体膜蛋白（CD62P）和血小板颗粒膜蛋白（CD63）水平，并随访6个月。结果对照组与观察组比较，1周时CD62P为（17.73±1.87）%vs（12.54±1.61）%，CD63为（16.85±1.53）% vs（12.66±1.32）%，2周时CD62P为（16.24±2.18）%vs（12.76±1.33）%，CD63为（15.96±1.75）% vs（12.87±1.29）%，差异均有统计学意义（P＜0.05或0.01）。12周时两组CD62P、CD63水平较基础值升高（均P＜0.05），而两组之间差异无统计学意义（均P＞0.05）。随访6个月内无一例发生主要心血管不良事件（MACE）。结论停用氯吡格雷后存在明显的血小板活性反跳现象，采用先减量后停药的方法，可减少此现象的发生。
목적관찰PCI환자록필격뢰취정혹축점감정후혈소판CD62P、CD63수평적변화。방법관상동맥약물세탈지가（DES）식입술후복용아사필림、록필격뢰쌍중항혈소판치료12개월이상자공64례입조，기중대조조32례입선후즉정복록필격뢰；관찰조32례격천복록필격뢰4주후완전정약。분별우입조시（0주）급입조후1、2、4、12주측정혈소판용매체막단백（CD62P）화혈소판과립막단백（CD63）수평，병수방6개월。결과대조조여관찰조비교，1주시CD62P위（17.73±1.87）%vs（12.54±1.61）%，CD63위（16.85±1.53）% vs（12.66±1.32）%，2주시CD62P위（16.24±2.18）%vs（12.76±1.33）%，CD63위（15.96±1.75）% vs（12.87±1.29）%，차이균유통계학의의（P＜0.05혹0.01）。12주시량조CD62P、CD63수평교기출치승고（균P＜0.05），이량조지간차이무통계학의의（균P＞0.05）。수방6개월내무일례발생주요심혈관불량사건（MACE）。결론정용록필격뢰후존재명현적혈소판활성반도현상，채용선감량후정약적방법，가감소차현상적발생。
Objective To observe the changes of platelet CD62P and CD63 concentrations after abrupt or gradual withdrawal of clopidogrel in patients underwent PCIl. Methods 64 patients being treated with dual antiplatelet drugs (aspirin and clopidogrel) more than 12 months after coronary drug- eluting stents implantation were enrol ed. Clopidogrel was stopped abruptly in 32 patients(control group) or taken every other day in 4 weeks and then stopped in other 32 patients (experimental group) . CD62P and CD63 were measured immediate before the study, and at 1,2,4 and 12 weeks later, respectively. They were fol owed up for 6 months. Results Compared with control group, CD62P and CD63 were significantly higher in experimental group at week 1 (17.73 ±1.87% vs 12.54 ±1.61%, 16.85 ±1.53% vs 12.66 ±1.32%, respectively, both P<0.01 ) and week 2 (16.24±2.18%vs 12.76±1.33%, 15.96±1.75%vs 12.87±1.29%, both P<0.05). CD62P and CD63 were significantly higher at week 12 than baseline in both groups, with no significant difference between groups. No main adverse cardiovascular event occurred during 6- month fol ow- up. Conclusion Rebound platelet reactivity is evident after discontinuation of clopidogrel. Reducing the dose of clopidogrel fol owed by withdrawal may alleviate this rebound phenomenon.