新疆地区维、汉民族PCI术后血栓弹力图检测下抗血小板药物抵抗差异性研究
发布时间：2018-07-26 17:25
【摘要】：目的:探讨通过血栓弹力图对接受PCI术的维、汉民族冠心病患者的抗血小板药物的血小板抑制率检测,分析不同民族间对抗血小板药物抵抗率是否存在差异,探讨抗血小板药物抵抗是否影响患者预后。方法:选取2015年8月至2016年10月在新疆维吾尔自治区人民医院心内科择期接受PCI治疗的冠心病患者128例,按照民族差异分为维吾尔族组68例和汉族组60例,所有患者于PCI术后抽血化验血栓弹力图,检测其AA诱导的血小板抑制率,ADP诱导的血小板抑制率,ADP诱导的凝血块强度(MAADP).分析不同民族间血小板抑制率是否存在差异。对所有患者出院后进行3个月的随访,记录其主要不良心血管事件(MACE)的发生情况。分析抗血小板药物抵抗与预后关系。结果:两组患者年龄、性别、个人史、相关疾病史无统计学意义(P0.05)。总共有22例(17.19%)患者发生氯吡格雷抵抗,其中汉族患者6例(10.00%),维族患者16例(23.53%),差异有统计学意义(P0.05)。共有13例(10.16%)患者发生阿司匹林抵抗,其中汉族患者6例(10.00%),维患者7例(10.29%),差异无统计学意义(P=0.956)。MAADP异常(≥50mm)的共有16人(12.50%),其中汉族患者中3人(5.00%)MAADP异常,维吾尔族患者中13人异常(19.12%),差异有统计学意义(P0.05)。3个月随访当中共有14位患者发生主要心血管不良事件(MACE),其中氯吡格雷反应正常的患者中发生MACE事件有8人,发生率为7.55%,而氯吡格雷抵抗的患者中发生MACE事件的有6人,发生率为27.27%,差异有统计学意义(P0.05)。阿司匹林反应正常的患者中发生MACE事件的有11人,MACE事件发生率为9.57%,阿司匹林抵抗的13例患者中有3人发生MACE事件,发生率为23.08%,差异无统计学意义(P0.05)。MAADP正常的患者中发生MACE事件的有9人,发生率为8.04%,MAADP异常的患者中发生MACE事件的有5人,发生率为31.25%,差异有统计学意义(P0.05)。结论:PCI术后维、汉民族患者之间阿司匹林抵抗无差异,而氯吡格雷抵抗存在差异,且维吾尔族患者氯吡格雷抵抗发生率较汉族患者高。PCI术后阿司匹林抵抗不增加MACE事件的发生率,而氯吡格雷抵抗增加MACE事件的发生率。PCI术后MAADP≥50mm时增加MACE事件的发生率。
[Abstract]:Objective: to investigate the platelet inhibition rate of antiplatelet drugs in patients with coronary heart disease (CHD) in Han nationality by thromboelastography, and to analyze whether there are differences in anti-platelet drug resistance rate among different nationalities. To investigate whether anti-platelet drug resistance affects the prognosis of patients. Methods: from August 2015 to October 2016, 128 patients with coronary heart disease received PCI treatment in cardiology department, Xinjiang Uygur Autonomous region people's Hospital, and were divided into Uygur group (68 cases) and Han nationality group (60 cases) according to their ethnic differences. Thromboelastograms were taken from all patients after PCI. The platelet inhibition rate induced by AA was measured. The platelet inhibition rate induced by ADP and clot strength (MAADP). Induced by ADP were measured. To analyze whether there are differences in platelet inhibition rate among different nationalities. All patients were followed up for 3 months after discharge to record the occurrence of major adverse cardiovascular events (MACE). To analyze the relationship between antiplatelet drug resistance and prognosis. Results: there was no significant difference in age, sex, personal history and related disease history between the two groups (P0.05). Clopidogrel resistance was found in 22 patients (17.19%), including 6 Han patients (10.00%) and 16 Uygur patients (23.53%). The difference was statistically significant (P0.05). Aspirin resistance was found in 13 patients (10.16%), including 6 patients (10.00%) in Han nationality and 7 cases (10.29%) in patients with Uygur. There was no significant difference (P < 0.956). There were 16 cases (12.50%) with abnormal MAADP and 3 cases (5.00%) with abnormal MAADP in Han nationality. 13 (19.12%) of Uygur patients were abnormal, the difference was statistically significant (P0.05). During the 3-month follow-up, there were 14 patients with major cardiovascular adverse events (MACE),) and 8 patients with normal clopidogrel reaction (clopidogrel). The incidence of clopidogrel resistance was 7.55 and 6 patients with clopidogrel resistance had MACE events, the incidence was 27.27, the difference was statistically significant (P0.05). The incidence of MACE events in 11 patients with normal aspirin reaction was 9.57, and that in 13 patients with aspirin resistance was 3. The incidence rate was 23.08, the difference was not statistically significant (P0.05). There were 9 cases of MACE events in the patients with normal MAADP, and 5 cases had the incidence of MACE events in the patients with abnormal MAADP of 8.04%, the incidence rate was 31.25%, the difference was statistically significant (P0.05). Conclusion there is no difference in aspirin resistance between Han nationality patients and clopidogrel resistance. The incidence of clopidogrel resistance in Uygur patients was higher than that in Han patients. Aspirin resistance after PCI did not increase the incidence of MACE events, while clopidogrel resistance increased the incidence of MACE events.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：2146741
[Abstract]:Objective: to investigate the platelet inhibition rate of antiplatelet drugs in patients with coronary heart disease (CHD) in Han nationality by thromboelastography, and to analyze whether there are differences in anti-platelet drug resistance rate among different nationalities. To investigate whether anti-platelet drug resistance affects the prognosis of patients. Methods: from August 2015 to October 2016, 128 patients with coronary heart disease received PCI treatment in cardiology department, Xinjiang Uygur Autonomous region people's Hospital, and were divided into Uygur group (68 cases) and Han nationality group (60 cases) according to their ethnic differences. Thromboelastograms were taken from all patients after PCI. The platelet inhibition rate induced by AA was measured. The platelet inhibition rate induced by ADP and clot strength (MAADP). Induced by ADP were measured. To analyze whether there are differences in platelet inhibition rate among different nationalities. All patients were followed up for 3 months after discharge to record the occurrence of major adverse cardiovascular events (MACE). To analyze the relationship between antiplatelet drug resistance and prognosis. Results: there was no significant difference in age, sex, personal history and related disease history between the two groups (P0.05). Clopidogrel resistance was found in 22 patients (17.19%), including 6 Han patients (10.00%) and 16 Uygur patients (23.53%). The difference was statistically significant (P0.05). Aspirin resistance was found in 13 patients (10.16%), including 6 patients (10.00%) in Han nationality and 7 cases (10.29%) in patients with Uygur. There was no significant difference (P < 0.956). There were 16 cases (12.50%) with abnormal MAADP and 3 cases (5.00%) with abnormal MAADP in Han nationality. 13 (19.12%) of Uygur patients were abnormal, the difference was statistically significant (P0.05). During the 3-month follow-up, there were 14 patients with major cardiovascular adverse events (MACE),) and 8 patients with normal clopidogrel reaction (clopidogrel). The incidence of clopidogrel resistance was 7.55 and 6 patients with clopidogrel resistance had MACE events, the incidence was 27.27, the difference was statistically significant (P0.05). The incidence of MACE events in 11 patients with normal aspirin reaction was 9.57, and that in 13 patients with aspirin resistance was 3. The incidence rate was 23.08, the difference was not statistically significant (P0.05). There were 9 cases of MACE events in the patients with normal MAADP, and 5 cases had the incidence of MACE events in the patients with abnormal MAADP of 8.04%, the incidence rate was 31.25%, the difference was statistically significant (P0.05). Conclusion there is no difference in aspirin resistance between Han nationality patients and clopidogrel resistance. The incidence of clopidogrel resistance in Uygur patients was higher than that in Han patients. Aspirin resistance after PCI did not increase the incidence of MACE events, while clopidogrel resistance increased the incidence of MACE events.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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