摘要
目的:分析经皮冠状动脉介入治疗(PCI)术后冠心病患者血小板高反应(HTPR)的发生率及危险因素。方法:选取2016年1月至2017年10月,在宣武医院行PCI的患者750例,根据血栓弹力图(TEG)结果,将腺苷二磷酸诱导的血小板聚集抑制率(ADP-PAI)<30%定义为氯吡格雷抵抗(CR),花生四烯酸诱导的血小板聚集抑制率(AA-PAI)<50%定义为阿司匹林抵抗(AR)。收集和分析患者的临床资料。结果:所有患者中,289例(38.5%)存在HTPR。73例(9.7%)存在AR,267例(35.6%)存在CR,51例(6.8%)同时存在AR及CR,238例(31.7%)是AR或CR的单一抵抗。Logistic回归分析显示,高脂血症是AR的危险因素(P<0.05),而女性是CR的危险因素(P<0.05)。老年(≥60岁)男性的AAPAI高于非老年(<60岁)男性(P<0.05);老年女性的AA-PAI低于同龄男性(P<0.05);ADP-PAI在老年人及非老年人中差异无统计学意义(P>0.05);老年患者组男性的ADP-PAI高于女性(P<0.05)。结论:PCI术后的冠心病患者,CR发生率明显高于AR。高脂血症是AR的危险因素,而女性更易发生CR。年轻男性AR风险比老年男性偏高,而老年女性AR及CR风险均高于老年男性。
Objective: To evaluate the prevalence and risk factors of high on-treatment platelet reactivity ( HTPR) in patients with coronary heart disease undergoing percutaneous coronary intervention ( PCI). Methods: 750 patients who had undergone PCI from January 2016 to October 2017 in XuanWu Hospital were collected. According to the result of thromboelastograph ( TEG),clopidogrel resistance ( CR) was defined as adenosine diphosphate ( ADP) induced platelet aggregation inhibition ( ADP-PAI) rate<30%,whereas aspirin resistance ( AR) was defined as arachidonic acid ( AA) induced platelet aggregation inhibition ( AA-PAI) rate <50%. The medical records of these patients were recorded and retrospectively reviewd. Results: Among all the patients included in this study,there were 289 cases ( 38. 5%) of HTPR. 73 cases ( 9. 7%) had aspirin resistance, 267 cases ( 35. 6%) were diagnosed as clopidogrel resistance. Aspirin and clopidogrel dural resistance in 51 ( 6. 8%) cases,238 cases ( 31. 7%) were single AR or CR resistance. Logistic regression analysis revealed that hyperlipidemia was independent risk factor of AR ( P<0. 05),while gender was independent risk factor of CR ( P<0. 05). AA-PAI in elderly ( age≥60 years) men was significantly higher than that of young ( age<60 years) men ( P<0. 05);elderly women were significantly lower than the men at the same age in AA-PAI. However, Young and elderly patients had similar ADP-PAI ( P>0. 05). In elderly patients group,men had higher ADP-PAI than the women ( P<0. 05). Conclusions: After PCI in patients with coronary artery disease,the incidence rate of CR is significantly higher than AR in clinical practice. Hyperlipemia is a independent risk factor for AR. Women are more likely expose to CR. In young patients,men have higher risk of AR. While in the elderly female patients get higher risk of AR and CR.
作者
任德旺
刘飞
夏经钢
姚青
杨禹
徐东
REN Dewang;LIU Fei;XIA Jinggang;YAO Qing;YANG Yu;XU Dong(Department of Cardiovascular Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《心肺血管病杂志》
2019年第7期725-730,共6页
Journal of Cardiovascular and Pulmonary Diseases
关键词
血栓弹力图
冠心病
血小板高反应
危险因素
Thrombelastograph
Coronary heart disease
High on-treatment platelet reactivity
Risk factors
