摘要
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300 mg＋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。
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 in60 cases of acute myocardial infarction.The platelet aggregation function was compared before and after anti-platelet therapy for 24 h and 1week.The plasma concentration of clopidogrel acid was detected and the correlation between concentration of clopidogrel acid and platelet aggregation was analyzed.Results The MAR induced by arachidonic acid,adenosine diphosphate and collagen were significantly decreased after antiplatelet treatment for 24 h（P〈0.01）; but after 1 week,no further reduce in platelet aggregation rate was found,which showed some tolerance.After 24 h,patients with MAR decreased by more than 30% accounted 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%,and34.6%,respectively,and those with MAR decreased less than 10% accounted for 34.6%,36.5% and 44.2%,respectively.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.
出处
《中国临床药理学杂志》
CAS
CSCD
北大核心
2015年第8期595-598,共4页
The Chinese Journal of Clinical Pharmacology
基金
安徽省教育厅重点基金资助项目(KJ2011A263)
关键词
急性心肌梗死
血小板最大聚集率
花生四烯酸
腺苷二磷酸
胶原
acute myocardial infarction
platelet maximum aggregation rate
arachidonic acid
adenosine diphosphate
collagen
