摘要
目的临床评估常规剂量氯吡格雷的血小板抑制性，探讨氯吡格雷低反应的临床特征及其预测因素。方法入选99例接受冠状动脉介入治疗并规律服用氯吡格雷1周以上的冠心病患者，通过VerifyNow—P2Y12系统检测氯吡格雷对血小板的抑制状况，并分别以血小板基线活性、P2Y12反应单位（PRU，代表血小板残余活性）及血小板抑制率来表示。详细记录所有入选者抗血小板药物的服用剂量和疗程、合并用药情况以及临床基线特征等。本研究以PRU~〈240为标准，将氯吡格雷服用后血小板反应性分为正常反应及低反应（即氯吡格雷抵抗），后者进一步根据基线活性及抑制率水平分为I型（即基线相关型，假性抵抗）、Ⅱ型（抑制率相关型，真性抵抗）和Ⅲ型（复合型）3种亚型。结果99例受检患者中氯吡格雷抵抗者48例（48．5％），其中Ⅰ、Ⅱ和Ⅲ型抵抗分别为9例（9．1％）、27例（27．3％）和12例（12．1％）；与男性相比，女性患者血小板基线活性较高（P〈0．01），同时PRU增高的人群比例较高（P〈0．01），女性为Ⅰ型抵抗的预测因素（OR=6．500，95％CI2．295～18．407，P〈0．01）；而体质指数（BMI）〉24kg／m2与氯吡格雷血小板抑制率显著相关（P〈0．05），提示为Ⅱ型抵抗的预测因素（OR=3．207，95％CI1．375～7．485，P〈0．01）。年龄、高血压、糖尿病、吸烟、高脂血症、c反应蛋白、合用泮托拉唑等因素与基线活性及血小板抑制率均无明显相关性。结论VerfyNow—P2Y12系统检测提示，氯吡格雷Ⅰ型抵抗因血小板基线活性过高所致，女性为高基线活性的独立预测因素；Ⅱ型抵抗因血小板抑制率过低所致，与氯吡格雷药理作用减弱有关，超重为其影响因素；Ⅲ型抵抗同时存在高基线及低抑制率的特征；年龄、高血压、糖尿病、吸烟、高脂血症、c反应蛋白及合用质
Objective To evaluate the platelet inhibition efficacy in patients under regular maintenance dose of clopidogrel by VerifyNow-P2Y12 assay and explore the clinical characteristics of elopidogrel non-responders and related predicting factors. Methods A total of 99 patients underwent percutaneous coronary intervention procedure and receiving clopidogrel in regular maintenance dose for at least 1 week were enrolled. Platelet reactivity, including baseline, P2Y12 reaction unit （PRU）, and platelet inhibition rate were measured with VeifyNow-P2Y12 assay. The dosage of anti-platelet drugs, combination with any other drugs, clinical characters in baseline of all enrolled patients were analyzed. PRU~〈240 was used as cut-off to identify elopidogrel responder and clopidogrel non-responder. In the non- responder group, patients were further separated into 3 sub-groups （ types ） according to the baseline and platelet inhibition rate： type Ⅰ with high baseline, high inhibition rate, representing false non-responder; type Ⅱ with low inhibition rate, representing true non-responder and type Ⅲ mixed type. Results In this study, 48 of 99 patients were found to be clopidogrel non-respouder （48.5%）. The ratio of type Ⅰ , type Ⅱ and type Ⅲ in the non-responder group was 9.1% （n=9）, 27. 3% （n=27）, and 12. 1% （n=12）,respectively. Baseline platelet value in female patients was significantly higher than in males （P 〈 0. 01 ）, number of females with high PRU also is higher than males （ P 〈 0. O1 ）, female gender was a predict factor for type I non-responder （ OR = 6. 5, 95% CI 2. 295 - 18.407, P 〈 0. 01 ）. BMI 〉 24 kg/m2 was a risk factor for clopidogrel non-responder （P 〈 0. 05 ）, and may be regarded as a predict factor for type 11 non- responder（OR = 3. 207,95% CI 1. 375 - 7. 485, P 〈 0. 01 ）. Age, hypertension, diabetics, smoking, hyperlipidemia, CRP and pantoprazole use do not show significant correlation with baseline and platelet inhibition rate. Conclusions Clop
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第8期662-666,共5页
Chinese Journal of Cardiology
