CAJ | 학술논문

目的：评价血小板功能监测在急性心肌梗死抗血小板治疗中的意义。方法60例急性心肌梗死患者入院后，立即予以负荷量氯吡格雷300mg+阿司匹林300 mg嚼服，随后以每日氯吡格雷75 mg+阿司匹林100 mg持续治疗；并进行花生四烯酸、腺苷二磷酸、胶原诱导的血小板最大聚集率测定，比较抗血小板治疗24 h、1周后血小板聚集功能；测定氯吡格雷酸的血药浓度，分析血小板聚集功能与氯吡格雷酸浓度的相关性。结果在治疗24 h后，急性心肌梗死患者花生四烯酸、腺苷二磷酸、胶原诱导的血小板最大聚集率均显著降低（ P＜0.01）。持续治疗1周后，血小板聚集率并没有再度降低，显示一定的耐受性。治疗24 h后，花生四烯酸、腺苷二磷酸、胶原诱导的血小板最大聚集率下降幅度＞30％的患者比例分别为36.7％，40.0％，21.7％；下降幅度10％～29％的患者比例分别为30.0％，23.3％，35.0％；下降幅度＜10％的患者比例分别为33.3％，36.7％，43.3％。随访半年后，34％的患者再发生心血管事件，其中55％的患者3种诱导的聚集率均小于30％。结论在相同的氯吡格雷和阿司匹林治疗下，当花生四烯酸、腺苷二磷酸、胶原诱导下的聚集率均小于30％，心血管事件再发生率显著提高，且氯吡格雷酸的血药浓度与血小板聚集功能不具有相关性。
목적：평개혈소판공능감측재급성심기경사항혈소판치료중적의의。방법60례급성심기경사환자입원후，립즉여이부하량록필격뢰300mg+아사필림300 mg작복，수후이매일록필격뢰75 mg+아사필림100 mg지속치료；병진행화생사희산、선감이린산、효원유도적혈소판최대취집솔측정，비교항혈소판치료24 h、1주후혈소판취집공능；측정록필격뢰산적혈약농도，분석혈소판취집공능여록필격뢰산농도적상관성。결과재치료24 h후，급성심기경사환자화생사희산、선감이린산、효원유도적혈소판최대취집솔균현저강저（ P＜0.01）。지속치료1주후，혈소판취집솔병몰유재도강저，현시일정적내수성。치료24 h후，화생사희산、선감이린산、효원유도적혈소판최대취집솔하강폭도＞30％적환자비례분별위36.7％，40.0％，21.7％；하강폭도10％～29％적환자비례분별위30.0％，23.3％，35.0％；하강폭도＜10％적환자비례분별위33.3％，36.7％，43.3％。수방반년후，34％적환자재발생심혈관사건，기중55％적환자3충유도적취집솔균소우30％。결론재상동적록필격뢰화아사필림치료하，당화생사희산、선감이린산、효원유도하적취집솔균소우30％，심혈관사건재발생솔현저제고，차록필격뢰산적혈약농도여혈소판취집공능불구유상관성。
Objective To evaluate the significance of platelet function monitoring in anti -platelet treatment of acute myocardial infarction . Methods The platelet maximum aggregation rates ( MAR ) induced by arachidonic acid , adenosine diphosphate and collagen were detected in 60 cases of acute myocardial infarction .The platelet aggregation function was compared before and after anti -platelet therapy for 24 h and 1 week.The plasma concentration of clopidogrel acid was detected and the correlation between concentration of clopidogrel acid and platelet aggrega-tion was analyzed.Results The MAR induced by arachidonic acid , adenosine diphosphate and collagen were significantly decreased after an-tiplatelet treatment for 24 h( P<0.01 );but after 1 week, no further re-duce in platelet aggregation rate was found , which showed some tole-rance.After 24 h, patients with MAR decreased by more than 30% ac-counted for 36.5%, 40.4% and 21.2%, respectively induced by arachidonic acid , adenosine diphosphate and collagen; patients with MAR decreased by 10% -29% accounted for 30.8%, 25%, and 34.6%,respectively,andthosewithMARdecreasedlessthan10%accountedfor34.6%,36.5%and44.2%,re-spectively.During half year follow -up, 34% of patients showed reoccurrence of cardiovascular events , and 55% of them were found aggregation rate less than 30%.Conclusion The aggregation rates under induction of arachidonic acid, adenosine diphosphate and collagen are all less than 30%when adopting the same anti -palate regime, but the incidence of cardiovascular events increased significantly and the platelet aggregation function and blood concentration of clopidogrel acid has no correlation .