CAJ | 학술논문

目的：探讨不同剂量氯吡格雷对急性冠状动脉综合征（ACS）患者氯吡格雷抵抗（CR）、血小板聚集率（PA ）及炎性因子水平的影响。方法选择98例 ACS 患者，分为观察组和对照组，每组49例。两组均常规行经皮冠状动脉介入治疗（PCI），对照组给予低负荷量氯吡格雷配合治疗，而观察组给予高负荷剂量氯吡格雷配合治疗，分别于服药前及服药后2、6、24和48 h 测定血小板聚集率（PA）、超敏 C 反应蛋白（hs‐CRP）水平，并评估氯吡格雷抵抗（CR）的发生情况。结果观察组 CR 发生率明显低于对照组，差异具有统计学意义（P＜0．05）。两组服药后 PA 均显著低于服药前，而观察组患者服药后2、6、24 h 显著低于对照组（P＜0．05）；两组服药6 h 后 hs‐CRP 水平均较服药前显著降低，而观察组在服药后6 h 和24 h 时 hs‐CRP 水平显著低于对照组（P＜0．05）。两组不良反应发生率比较差异无统计学意义（P＞0．05）。结论高剂量的氯吡格雷对 ACS 患者具有更好的疗效，能够更加有效地抑制血小板聚集，降低 CR 发生率及炎性因子水平，且不良反应较少，得临床大力推广和应用。
목적：탐토불동제량록필격뢰대급성관상동맥종합정（ACS）환자록필격뢰저항（CR）、혈소판취집솔（PA ）급염성인자수평적영향。방법선택98례 ACS 환자，분위관찰조화대조조，매조49례。량조균상규행경피관상동맥개입치료（PCI），대조조급여저부하량록필격뢰배합치료，이관찰조급여고부하제량록필격뢰배합치료，분별우복약전급복약후2、6、24화48 h 측정혈소판취집솔（PA）、초민 C 반응단백（hs‐CRP）수평，병평고록필격뢰저항（CR）적발생정황。결과관찰조 CR 발생솔명현저우대조조，차이구유통계학의의（P＜0．05）。량조복약후 PA 균현저저우복약전，이관찰조환자복약후2、6、24 h 현저저우대조조（P＜0．05）；량조복약6 h 후 hs‐CRP 수평균교복약전현저강저，이관찰조재복약후6 h 화24 h 시 hs‐CRP 수평현저저우대조조（P＜0．05）。량조불량반응발생솔비교차이무통계학의의（P＞0．05）。결론고제량적록필격뢰대 ACS 환자구유경호적료효，능구경가유효지억제혈소판취집，강저 CR 발생솔급염성인자수평，차불량반응교소，득림상대력추엄화응용。
Objective To explore the effects of different dose of clopidogrel on clopidogrel resistance ,platelet aggregation rate and inflammatory factor level of patients with acute coronary syndrome .Methods Totally 98 cases of acute coronary syndrome patients were randomly divided into the observation group and the control group two groups according to the order of treatment ,49 cases in each group .The two groups were treated with conventional percutaneous coronary artery intervention (PCI) ,and the con‐trol group was treated with low dose clopidogrel ,while the observation group was given high loading dose of clopidogrel .The deter‐mination of platelet aggregation rate (PA ) and inflammatory factor hypersensitive C‐reactive protein (hs‐CRP) level respectively before treatment and after treatment 2 ,6 ,24 and 48 h were observed ,and the clopidogrel resistance (CR) occurrence of two groups were assessed .Results The CR of observation group was significantly lower than the control group ,the difference statistically sig‐nificant (P< 0 .05) .The rate of platelet aggregation of two groups after taking were significantly lower than that before treatment and the observation group patients after taking 2 ,6 ,24 h ,platelet aggregation rate was significantly lower than the control group (P< 0 .05) .The hs‐CRP levels with 6 h of two groups were significantly lower than before treatment ,and the hs‐CRP levels with 6 h and 24 h of observation group were significantly lower than those of control group (P< 0 .05) .The incidence of adverse reactions had no significant difference between two groups (P> 0 .05) .Conclusion High dose of clopidogrel has better curative effect in pa‐tients with acute coronary syndrome ,and can more effectively inhibit platelet aggregation ,reduce the incidence of clopidogrel resist‐ance and the levels of inflammatory factors ,fewer adverse reactions ,and worth the clinical promotion and application .