冠心病患者阿司匹林与氯吡格雷抵抗发生情况的调查研究
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国家自然科学基金资助(81170181)


Incidence of aspirin and clopidogrel resistance in patients with coronary artery disease
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    摘要:

    目的:调查经皮冠状动脉介入治疗(PCI)术后冠心病患者阿司匹林与氯吡格雷抵抗的发生情况,为个体化抗血小板治疗提供依据。方法:入选确诊为冠心病并接受PCI的患者200例,用光学血小板聚集仪(LTA)检测1 mmol/L花生四烯酸(AA)和5 μmol/L二磷酸腺苷(ADP)诱导的血小板聚集率(PLAA和PLADP),将PLAA > 20%-PLADP > 40%分别定义为阿司匹林抵抗和氯吡格雷抵抗。结果:本研究未发现阿司匹林抵抗患者,入选患者PLAA均值为(2.63 ± 2.40)%;入选患者中氯吡格雷抵抗者44例(22.0%),其PLADP均值为(47.16 ± 5.82)%;氯吡格雷非抵抗者156例(78.0%),其PLADP均值为(25.62 ± 8.71)%。结论:冠心病患者阿司匹林抵抗发生率极低,而氯吡格雷抵抗发生率较高,提示应针对氯吡格雷抵抗者制定个体化抗血小板治疗方案。

    Abstract:

    Objective:To investigate the incidence of aspirin and clopidogrel resistance in patients with coronary artery disease received percutaneous coronary intervention (PCI),and provide evidence for the individualized anti-platelet treatment. Methods:Two hundreds patients with defined coronary artery disease who have received PCI were recruited in this study. Platelet aggregations (PLAA and PLADP) 1 mmol/L arachidonic acid (AA) and 5 μmol/L adenosine diphosphate (ADP) were determined using the light transmission aggregometer (LTA). Aspirin and clopidogrel resistance were defined as PLAA >20% and PLADP >40%,respectively. Results:None of the patients was resistant to aspirin in the recruited subjects;the mean PLAA of the recruited patients was (2.63 ± 2.40)%. Forty four patients (22.0%) were resistant to clopidogrel,and the mean PLADP of the non-responders was (47.16 ± 5.82)%;by contrast,156 patients (78.0%) were sensitive to clopidogrel,and the mean PLADP of the responders was (25.62 ± 8.71)%. Conclusion:Aspirin resistance is rare,while clopidogrel resistance is much common in patients with coronary artery disease,which suggests that individualized anti-platelet treatment should be initiated targeting patients with clopidogrel resistance.

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孔德玉,陈 俊,李春坚,朱甜甜,张 秋,刘 洁,龚晓璇,张定国,贾恩志,陈 波,陈磊磊,贾庆哲,戴振华,杨志健.冠心病患者阿司匹林与氯吡格雷抵抗发生情况的调查研究[J].南京医科大学学报(自然科学版),2013,(6):788-791

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  • 收稿日期:2013-02-27
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  • 在线发布日期: 2013-06-25
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