摘要
目的 探讨冠心病患者经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)+常规抗血小板药物治疗后血小板抑制率的水平及相关影响因素。方法 选取2021年8月至2022年7月择期行PCI治疗的冠心病患者437例,术前口服阿司匹林及氯吡格雷均至少达到300 mg,术后常规口服阿司匹林每日100 mg及氯吡格雷每日75 mg,术后24 h通过血栓弹力图检测花生四稀酸(arachidonic acid, AA)、二磷酸腺苷(adenosine diphosphate, ADP)诱导的血小板抑制率及ADP诱导的曲线最大幅度(maximum amplitude, MA)值。按照血小板反应性分为AA诱导的血小板高反应组(AAH组)、AA诱导的血小板非高反应组(AAN组)、ADP诱导的血小板高反应组(ADPH组)和ADP诱导的非血小板高反应组(ADPN组)。采用多因素logistic回归分析其相关危险因素。结果 AAH组吸烟史、血尿酸水平高于AAN组(P<0.05),ADPH组糖尿病、血尿酸水平高于ADPN组(P <0.05),而各组性别、年龄、体重指数、高血压、血小板计数、血脂及糖化血红蛋白等指标比较,差异无统计学意义(P> 0.05);多因素logistic回归分析显示吸烟是AA诱导的高血小板反应性的独立危险因素(OR=1.967,95%CI:0.783~3.942,P=0.041),糖尿病和高尿酸血症是ADP诱导的血小板高反应性的危险因素(OR=2.447,95%CI:1.207~3.966,P=0.041;OR=3.231,95%CI:1.113~6.472,P=0.023)。结论 对于服用阿司匹林及氯吡格雷双抗治疗的冠心病患者,糖尿病及高尿酸血症与氯吡格雷抵抗有一定的相关性,而吸烟可能会减弱阿司匹林的抗血小板作用。
Objective To observe the level of platelet inhibition rate and potential factors in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 437 patients with coronary heart disease undergoing elective PCI between August 2021 and July 2022 were selected.Before the operation,the patients took at least 300 mg of aspirin and clopidogrel.The platelet inhibition rate induced by arachidonic acid(AA)and adenosine diphosphate(ADP)and the maximum amplitude(MA)value of ADP-induced curve were detected by thromboelastography 24 hours after PCI.According to platelet reactivity,the patients were divided into AAH group(AA-induced platelet high reactivity group),AAN group(AA-induced non platelet high reactivity group),ADPH group(ADP-induced platelet high reactivity group)and ADPN group(ADP-induced non platelet high reactivity group)to analyze related risk factors.Results The proportion of smoking history and blood uric acid level in the AAH group were higher than those in the AAN group(both P<0.05),and the proportion of diabetes and blood uric acid level in the ADPH group were higher than those in the ADPN group(both P<0.05),however,there were no significant differences in gender,age,body mass index,hypertension,platelet count,blood lipids and glycosylated hemoglobin among the groups.Multivariate logistic regression analysis showed that smoking was an independent risk factor for AA-induced high platelet reactivity,and diabetes and hyperuricemia were risk factors for ADP-induced high platelet reactivity.Conclusion For patients with coronary heart disease taking aspirin and clopidogrel dual-antibody therapy,diabetes and hyperuricemia are related to clopidogrel resistance,and smoking may weaken the antiplatelet effect of aspirin.
作者
梁明亭
庞英
崔晓宁
宫颖
赵杰
LIANG Mingting;PANG Ying;CUI Xiaoning;GONG Ying;ZHAO Jie(Department of Cardiology,Liaocheng People's Hospital,Liaocheng 252000,Shandong;Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)
出处
《中国分子心脏病学杂志》
CAS
2023年第4期5507-5512,共6页
Molecular Cardiology of China
关键词
冠心病
抗血小板治疗
血小板高反应性
氯吡格雷抵抗
Coronary heart disease
Antiplatelet therapy
High platelet reactivity
Clopidogrel resistance
