不同抗血小板方案对急性冠状动脉综合征经皮冠状动脉介入术后患者的疗效与安全性研究

被引：4

作者：

李彪 ^{[1
,2
]}

周涛龙 ^{[1
,2
]}

赵强 ^{[1
,2
]}

吴同果 ^{[1
,2
]}

韦建瑞 ^{[1
,2
]}

机构：

[1] 暨南大学第四附属医院

[2] 广州市红十字会医院心血管内科

来源：

中华临床医师杂志(电子版) | 2013年 / 7卷 / 15期

基金：

广东省科技计划;

关键词：

急性冠状动脉综合征; C反应蛋白质; 氯吡格雷抵抗; 全血阻抗法;

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：

1002 ; 100201 ;

摘要：

目的探讨不同强化抗血小板治疗方案对急性冠状动脉综合征(ACS)经皮冠状动脉介入术(PCI)后患者氯吡格雷抵抗(CR)发生率及超敏C-反应蛋白(hs-CRP)的影响。方法将125例确诊为ACS急诊行PCI术后的患者,随机分为三组,A组(n=42):口服阿司匹林100 mg Qd+氯吡格雷75 mg Qd;B组(n=42):口服阿司匹林100 mg Qd+氯吡格雷75 mg Bid;C组(n=41):口服阿司匹林100 mg Qd+氯吡格雷75 mg Qd+西洛他唑50 mg Bid。利用全血电阻抗法检测治疗前、治疗第7天的血小板聚集率,酶联免疫吸附法测定PCI前、PCI术后24 h、PCI术后第7天的hs-CRP,计算并比较CR的发生率,观察住院期间主要不良心脏事件(MACE)发生率、出血并发症。结果 B组与C组的CR发生率无显著差异(16.7%vs.14.6%),两组均明显低于A组(35.7%)(P<0.05);B组和C组PCI术后24 h、PCI术后第7天的hs-CRP水平无显著差异[(12.5±7.4)mg/L vs.(12.8±7.1)mg/L,(9.2±6.8)mg/L vs.(8.5±6.3)mg/L],两组均明显低于A组[(16.7±6.3)mg/L,(11.8±5.4)mg/L,P<0.05];B组和C组MACE发生率明显低于A组[(2.4%,2.4%)vs.16.7%](P<0.05);C组出血率明显高于A组和B组[14.6%vs(.2.4%,2.4%)](P<0.05)。结论两种强化抗血小板治疗方案均明显降低ACS急诊PCI术后患者CR发生率和hs-CRP水平,标准双联抗血小板联合西洛他唑方案的出血发生率明显低于阿司匹林联合双倍氯吡格雷方案。

引用

页码：6825 / 6828

页数：4

共 8 条

[1]

Clinical Outcome Following Stringent Discontinuation of Dual Antiplatelet Therapy After 12 Months in Real-World Patients Treated With Second-Generation Zotarolimus-Eluting Resolute and Everolimus-Eluting Xience V Stents[J] . Kenneth Tandjung,Hanim Sen,Ming Kai Lam,Mounir W.Z. Basalus,J. (Hans) W. Louwerenburg,Martin G. Stoel,K. Gert van Houwelingen,Frits H.A.F. de Man,Gerard C.M. Linssen,Salah A.M. Sa?d,Mark B. Nienhuis,Marije M. L?wik,Patrick M.J. Verhorst,Job van der Palen,Clemens von Bi

[2]

Ticagrelor: The first approved reversible oral antiplatelet agent[J] . Divya Goel. International Journal of Applied and Basic Medical Research . 2013 (1)

[3]

High-sensitivity C-reactive protein predicts adverse outcomes after non-ST-segment elevation acute coronary syndrome regardless of GRACE risk score, but not after ST-segment elevation myocardial infarction[J] . Revista Portuguesa de Cardiologia . 2012

[4]

Inflammation-Induced Thrombosis: Mechanisms, Disease Associations and Management[J] . Kenan Aksu,Ayhan Donmez,Gokhan Keser. Current Pharmaceutical Design . 2012 (11)

[5] Relation of Genetic Polymorphisms in the Cytochrome P450 Gene With Clopidogrel Resistance After Drug-Eluting Stent Implantation in Koreans [J].

Lee, Jung Myung ;

Park, Sungha ;

Shin, Dong-Jik ;

Choi, Donghoon ;

Shim, Chi Young ;

Ko, Young-Guk ;

Kim, Jung-Sun ;

Shin, Eun-Soon ;

Chang, Chong Won ;

Lee, Jong-Eun ;

Jang, Yangsoo .

AMERICAN JOURNAL OF CARDIOLOGY, 2009, 104 (01) :46-51

[6]

Design and rationale of CURRENT-OASIS 7: A randomized, 2 × 2 factorial trial evaluating optimal dosing strategies for clopidogrel and aspirin in patients with ST and non–ST-elevation acute coronary syndromes managed with an early invasive strategy[J] . Shamir R. Mehta,Jean-Pierre Bassand,Susan Chrolavicius,Rafael Diaz,Keith A.A. Fox,Christopher B. Granger,Sanjit Jolly,Hans-Jurgen Rupprecht,Petr Widimsky,Salim Yusuf. American Heart Journal . 2008 (6)

[7]

Clopidogrel nonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: A systematic review and meta-analysis[J] . Jaapjan D. Snoep,Marcel M.C. Hovens,Jeroen C.J. Eikenboom,Johanna G. van der Bom,J. Wouter Jukema,Menno V. Huisman. American Heart Journal . 2007 (2)

[8] Contribution of hepatic cytochrome P450 3A4 metabolic activity to the phenomenon of clopidogrel resistance [J].

Lau, WC ;

Gurbel, PA ;

Watkins, PB ;

Neer, CJ ;

Hopp, AS ;

Carville, DGM ;

Guyer, KE ;

Tait, AR ;

Bates, ER .

CIRCULATION, 2004, 109 (02) :166-171

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