CAJ | 학술논문

目的：通过血栓弹力图（TEG）监测ADP诱导的血小板抑制率，观察高龄老年冠心病患者口服氯吡格雷抵抗时更换为替格瑞洛的疗效。方法选择自2012年10月~2014年12月于北京军区总医院干部病房一、四科及心血管内科住院的75岁以上老年急性冠脉综合征（ACS）及经皮冠状动脉介入（PCI）术后氯吡格雷抵抗的患者31例（ACS10例，PCI术后21例），其中男性27例，女性4例。分为氯吡格雷组（15例）及替格瑞洛组（16例），氯吡格雷组继续服用氯吡格雷（75 mg 1/日），替格瑞洛组更换为替格瑞洛（90 mg 2/日），连续治疗8周。分别于服药前、服药后1、4、8周观察ADP诱导的血小板抑制率的变化，并比较两组主要不良心血管事件的发生情况。结果与氯吡格雷组比较，替格瑞洛组治疗1周、4周以及8周后，ADP诱导的血小板抑制率升高，为[（22.6±4.5）%vs.（35.8±5.7）%]、[（21.9±4.6）%vs.（36.9±5.5）%]、[（22.8±4.6）%vs.（37.1±5.2）%]，差异有统计学意义（P均＜0.05）。氯吡格雷组心肌梗死1例，再发心绞痛5例，总计6例（40%）；替格瑞洛组轻度呼吸困难1例，未做特殊处理3 d后呼吸困难缓解，再发心绞痛1例，总计1例（6.3%）。氯吡格雷组主要不良心血管事件发生率较替格瑞洛组升高（40%vs.6.3%），差异有统计学意义（P＜0.05）。结论高龄老年冠心病氯吡格雷抵抗患者将氯吡格雷更换为替格瑞洛，明显升高ADP诱导的血小板抑制率，减少主要不良心血管事件，具有良好的安全性和耐受性。
목적：통과혈전탄력도（TEG）감측ADP유도적혈소판억제솔，관찰고령노년관심병환자구복록필격뢰저항시경환위체격서락적료효。방법선택자2012년10월~2014년12월우북경군구총의원간부병방일、사과급심혈관내과주원적75세이상노년급성관맥종합정（ACS）급경피관상동맥개입（PCI）술후록필격뢰저항적환자31례（ACS10례，PCI술후21례），기중남성27례，녀성4례。분위록필격뢰조（15례）급체격서락조（16례），록필격뢰조계속복용록필격뢰（75 mg 1/일），체격서락조경환위체격서락（90 mg 2/일），련속치료8주。분별우복약전、복약후1、4、8주관찰ADP유도적혈소판억제솔적변화，병비교량조주요불양심혈관사건적발생정황。결과여록필격뢰조비교，체격서락조치료1주、4주이급8주후，ADP유도적혈소판억제솔승고，위[（22.6±4.5）%vs.（35.8±5.7）%]、[（21.9±4.6）%vs.（36.9±5.5）%]、[（22.8±4.6）%vs.（37.1±5.2）%]，차이유통계학의의（P균＜0.05）。록필격뢰조심기경사1례，재발심교통5례，총계6례（40%）；체격서락조경도호흡곤난1례，미주특수처리3 d후호흡곤난완해，재발심교통1례，총계1례（6.3%）。록필격뢰조주요불양심혈관사건발생솔교체격서락조승고（40%vs.6.3%），차이유통계학의의（P＜0.05）。결론고령노년관심병록필격뢰저항환자장록필격뢰경환위체격서락，명현승고ADP유도적혈소판억제솔，감소주요불양심혈관사건，구유량호적안전성화내수성。
Objective To observe the curative effect of ticagrelor in elderly patients with coronary heart disease (CHD) and clopidogrel resistance through monitoring ADP-induced platelet inhibition rate by using thrombelastogram (TEG). Methods The elderly patient with acute coronary syndrome (ACS) and clopidogrel resistance after percutaneous coronary intervention (PCI, n=31, including 10 with ACS and 21 with PCI, male 27, female 4 and aged over 75) were chosen from Oct. 2012 to Dec. 2014, and divided into clopidogrel group (n=15) and ticagrelor group (n=16). The clopidogrel group was keeply given clopidogrel (75 mg/d) and ticagrelor group was given ticagrelor (90 mg) twice a day for 8 w. The changes of platelet inhibition rate were observed at different time points including before, 1 w, 4 w, and 8 w after drug taking. The incidence of major adverse cardiovascular events (MACE) was compared between 2 groups. Results Compared with clopidogrel group, ADP-induced platelet inhibition rate increased in ticagrelor group after 1 w [(22.6±4.5)%vs. (35.8±5.7)%], 4 w [(21.9±4.6)%vs. (36.9 ±5.5)%] and 8 w [(22.8±4.6)%vs. (37.1±5.2)%, all P<0.05]. There was 1 case with myocardial infarction, 5 with relapsed angina pectoris (totally 6, 40%) in clopidogrel group, and 1 with mild dyspnea (relieved after 3 d without any special treatment) and 1 with relapsed angina pectoris (totally 1, 6.3%) in ticagrelor group. The incidence of MACE was higher in clopidogrel group than that in ticagrelor group (40% vs. 6.3%, P<0.05). Conclusion Clopidogrel is replaced with ticagrelor can significantly increase ADP-induced platelet inhibition rate and decrease incidence of MACE with higher safety and tolerability in elderly patients with CHD and clopidogrel resistance.