摘要
目的探讨急性冠状动脉综合征（ACS）患者接受经皮冠状动脉介入（PCI）、氯吡格雷治疗后发生血小板高反应性（HPR）的危险因素及危险因素预测HPR的效力。方法 392例接受PCI治疗的ACS患者,术后予氯吡格雷75 mg·d-1维持剂量服用5 d后晨起空腹接受血栓弹力图（TEG）检查,根据对二磷酸腺苷（ADP）诱导的血小板抑制率的测定结果分为氯吡格雷治疗后HPR组（n=53）和氯吡格雷治疗后血小板低反应性（LPR）组（n=339）,比较两组患者一般临床资料、实验室指标、TEG参数和手术资料,多因素logistic回归分析HPR的影响因素。利用受试者工作曲线（ROC curve）检验独立危险因素MAADP预测HPR的效力。结果 392例ACS患者HPR发生率为13.5%。两组患者的糖尿病、血红蛋白、MAADP、阿司匹林抑制率、阿司匹林抵抗、多支血管病变（MVD）的差异有显著意义（P〈0.05或P〈0.01）。条件logistic回归分析结果示HPR的独立危险因素有糖尿病（OR=2.670,95%CI：1.190~5.986,P=0.017）、MAADP（OR=1.189,95%CI=1.136~1.245,P〈0.001）、糖尿病和MVD的交互作用（OR=6.975,95%CI：2.618~18.580,P〈0.001）。利用MAADP预测HPR的ROC曲线下面积（AUC）为0.939（95%CI：0.914~0.964,P〈0.001）。当MAADP取最佳临界值（cutpoint）47.65%时,诊断氯吡格雷抵抗的敏感性为92.45%,特异性为87.32%,阳性预测值为53.26%,阴性预测值为98.67%。结论糖尿病、MAADP和多支血管病变的交互作用为ACS患者HPR的独立危险因素,通过MAADP预测HPR的效力良好。
AIM To explore the risk factors of high on- treatment platelet reactivity（HPR） in patients of clopidogrel treatment with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI） and to investigate the role of independent risk factors in predicting HPR. METHODS A total of 392 patients with ACS who underwent PCI were enrolled. Clopidogrel of 75 mg·d-1ongoing dose was administered after PCI.Patients were divided into HPR group and low on- treatment platelet reactivity group（LPR group） according to the ADP- induced platelet aggregation inhibition rate. The general clinical data, laboratory data, thromboelastography（ TEG） parameters and procedural characteristics were compared between two groups, and the independent risk factors of HPR were explored by logistic regression analysis. A receiver operating characteristic（ ROC） curve was used to evaluate the efficacy of independent risk factors（ MAADP） in predicting HPR.RESULTS The incidence of HPR after PCI was 13.5% in the 392 patients under study. Significant differences were found in patients with diabetes, hemoglobin, MAADP, aspirin inhibitor rate, aspirin resistance,multivessel disease（ MVD） between two groups. Logistic regression analysis revealed that diabetes（ OR =2.670, 95%CI： 1.190- 5.986, P = 0.017）, MAADP（ OR = 1.189, 95% CI： 1.136- 1.245, P〈0.001）,interaction between diabetes and MVD（OR = 6.975, 95%CI： 2.618- 18.580, P〈0.001） were independent risk factors of HPR. The results of ROC curve demonstrated a satisfactory predictive value for MAADP, with the area under the curve being 0.939（95%CI： 0.914- 0.964, P〈0.001）. When the MAADPwas at the optimal cut point（ 47.65%）, the sensitivity, specificity, positive predictive value and negative predictive value in diagnosing HPR were 92.45%, 87.32%, 53.26%, 98.67%, respectively. CONCLUSION Diabetes, MAADP,interaction between diabetes and MVD may be risk factors of HPR in ACS patients after PCI. MAADPholds a satisfactory predictive value
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2015年第10期778-783,共6页
Chinese Journal of New Drugs and Clinical Remedies
基金
上海医院药学科研项目(2014-YY-01-20)
