摘要
目的观察吸烟对冠心病心绞痛型患者经皮冠状动脉介入治疗(PCI)术后二联抗血小板疗效的影响。方法冠心病心绞痛PCI术后患者493例,均连续服用阿司匹林100mg/d达7d以上,根据病史分为吸烟组241例和非吸烟组252例,入选时所有患者均测定花生四烯酸(AA)和二磷酸腺苷(ADP)诱导的血小板聚集率,后予氯吡格雷300mg负荷量口服,并于服用氯吡格雷75mg/d3d后再次测定ADP诱导的血小板聚集率。结果吸烟组与非吸烟组在性别、红细胞计数、血小板计数、血小板压积和低密度脂蛋白胆固醇等方面无显著性差异(P>0.05)。两组阿司匹林抵抗和半抵抗的总发生率为19.1%;吸烟组阿司匹林抵抗和半抵抗的发生率高于非吸烟组(25.5%vs14.3%,P=0.027),年龄(OR=3.79,95%CI:1.77～8.12)和吸烟(OR=1.98,95%CI:1.18～4.43)是阿司匹林抵抗和半抵抗的独立危险因素。两组氯吡格雷抵抗发生率为19.5%,吸烟组氯吡格雷抵抗的发生率低于非吸烟组(13.2%vs24.3%,P=0.03),吸烟是氯吡格雷抵抗的保护因素(OR=0.22,95%CI:0.09～0.54)。结论吸烟降低阿司匹林的抗血小板效应,但增强氯吡格雷的抗血小板效应。
Objective To explore the association of smoking to the Aspirin and Clopidogrel antiplatelet in patients with stable angina after percutaneous coronary intervention（PCI）.Methods241 smoking patients and 252 non-smoking patients underwent PCI for stable coronary artery disease,all patients had taken aspirin 100 mg/d for 7 d or more.The arachidonic acid（AA）-and adenosine diphosphate（ADP）-induced platelet aggregation were tested as they got in hospital.Then,they accepted Clopidogrel 300 mg as loading dose,continued with 75 mg/d for 3 d.The ADP-induced platelet aggregation were re-tested.ResultsThe incidence of aspirin resistance（AR）and aspirin semiresponder（ASR）was 19.1% in all the cases,and was 25.5% in smoking group,14.3% in non-smoking group（P=0.027）.Age（OR=3.79,95%CI：1.77～8.12）and smoking（OR=1.98,95%CI：1.18～4.43）were the independent risk factors of AR and ASR.The incidence of Clopidogrel resistance was 19.5% in all the cases,and was 13.2% in smoking group,24.3% in non-smoking group（P=0.03）.Smoking（OR=0.22,95%CI：0.09～0.54）may reduce the risk of Clopidogrel resistance.ConclusionSmoking increased the risk of AR and ASR,but reduced the risk of Clopidogrel resistance.
出处
《中国康复理论与实践》
CSCD
2010年第11期1057-1059,共3页
Chinese Journal of Rehabilitation Theory and Practice
