冠心病患者氯吡格雷抵抗与血小板参数的相关性分析

被引:40
作者
李蕾 [1 ]
韩江莉 [1 ]
李海燕 [1 ]
乔蕊 [2 ]
于海奕 [1 ]
张捷 [2 ]
高炜 [1 ]
机构
[1] 北京大学第三医院心内科
关键词
冠状动脉疾病; 血小板计数; 氯吡格雷抵抗; 平均血小板体积;
D O I
暂无
中图分类号
R541.4 [冠状动脉(粥样)硬化性心脏病(冠心病)];
学科分类号
摘要
目的观察冠心病患者氯吡格雷抵抗(CR)的发生率及其对临床预后的影响,并探讨血小板参数与CR的相关性。方法入选2007年7一12月北京大学第三医院心内科住院的152例冠心病患者,所有患者在给予氯吡格雷负荷剂量300 mg口服后改为维持剂量75 mg/d。在患者服药后第5~7天,采用全血电阻法(EIA)检测氯吡格雷对血小板聚集的抑制程度。血小板自发聚集(电阻≥10Ω)定义为CR。根据检测结果将患者分为CR组和氯吡格雷敏感(CS)组,比较两组临床资料、血生化指标和血小板参数。对所有患者进行临床随访,记录患者心血管事件发生情况,包括再发心肌梗死、支架再狭窄、支架内血栓、再介入和心源性死亡。结果共有16例(10.5%)患者发生CR。CR组合并糖尿病患者的比例显著高于CS组(7/16比29/136,P=0.046)。CR组血小板计数和平均血小板体积(MPV)显著高于CS组[(241±58)×10~9/L比(185±56)×10~9/L,P=0.005;(8.0±0.8)fl比(7.4±0.9)fl,P=0.024]。回归分析显示,血小板计数每增加10 x 10~9/L,患者发生CR的风险升高0.376倍(OR=1.376,95%CI1.097~1.725,P=0.006);MVP每增加1 fl,患者发生CR的风险升高1.015倍(OR=2.015,95%,CI1.148~3.537,P=0.015)。对所有患者平均临床随访53个月,结果显示CR组心血管事件发生率显著高于CS组(6/16比23/136,P=0.047)。结论发生CR的冠心病患者心血管事件发生率高。而血小板计数和MPV升高与冠心病患者CR发生率相平行,可作为CR的有效预测因素。
引用
收藏
页码:916 / 920
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