吸烟对氯吡格雷抗血小板聚集及安全性影响的初步研究

发布时间：2018-04-29 13:42

本文选题：冠心病PCI术后 + 吸烟　；参考：《山西医科大学》2017年硕士论文

【摘要】：研究背景:吸烟是公认的冠心病的危险因素,然而,国外很多研究表明,吸烟者比非吸烟者更能显著地从氯吡格雷中获益。这一有悖于常识的结论受到人们广泛关注,但至今仍无定论。目的:通过检测吸烟组、非吸烟组患者应用氯吡格雷后血小板的抑制率,随访主要不良心血管事件(major adverse cardiovascular events,MACE)、出血情况,探讨吸烟对氯吡格雷抗血小板聚集作用及安全性的影响。方法:采用回顾性研究方法,分析2016年1月至10月在火箭军总医院接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)且术后应用血栓弹力图(thrombelastography,TEG)监测抗血小板疗效的患者151例。依据是否吸烟分为两组:吸烟组(n=72)和非吸烟组(n=79)。检测术后3天及1月的血栓弹力图结果,记录氯吡格雷的血小板抑制率数据。随访住院期间及术后6个月内的MACE及出血事件。收集的数据采用SPSS 20.0软件进行分析。结果:两组患者的临床基线情况比较差异无统计学意义(p0.05)。PCI术后3天,应用TEG检测血小板抑制率。血小板抑制率(ADP%),吸烟组为80.94±22.57,非吸烟组为66.65±26.25,吸烟组高于非吸烟组,两组间差异有统计学意义(p=0.01)。血小板抑制率(AA%),吸烟组为83.83±23.65,非吸烟组为82.97±18.93,两组间差异无统计学意义(p=0.81)。术后1个月复测血栓弹力图,血小板抑制率(ADP%),吸烟组为81.64±20.37,非吸烟组为69.15±22.89,吸烟组仍高于非吸烟组,两组间差异有统计学意义(p=0.01)。血小板抑制率(AA%),吸烟组为84.01±23.45,非吸烟组为83.18±18.43,两组间差异无统计学意义(p=0.81)。随访6个月内,两组间MACE及出血事件,吸烟组MACE发生7例,出血情况发生3例,非吸烟组MACE发生9例,出血事件发生4例,两组间MACE及出血事件差异无统计学意义(p0.05)。结论:1.吸烟可以增强氯吡格雷的抗血小板聚集作用2.在随访期内,两组间MACE及出血事件差异无统计学意义,本研究未能证明吸烟者比非吸烟者更能从氯吡格雷中临床获益。
[Abstract]:Background: smoking is a recognized risk factor for coronary heart disease. However, many foreign studies have shown that smokers benefit more from clopidogrel than non-smokers. This conclusion, which runs counter to common sense, has received widespread attention, but it is still inconclusive. Objective: to investigate the effects of smoking on the antiplatelet aggregation and safety of clopidogrel in patients with smoking and non-smoking groups by detecting the inhibition rate of platelet and the bleeding of major adverse cardiovascular events. Methods: a retrospective study was carried out in 151 patients who received percutaneous coronary interventionation from January to October 2016 in Rocket Army General Hospital and monitored the antiplatelet effect by thromboelastography technique. Smoking was divided into two groups: smoking group (n = 72) and non-smoking group (n = 79). Thromboelastogram results were measured 3 days and 1 month after operation, and platelet inhibition rates of clopidogrel were recorded. MACE and bleeding events were followed up during hospitalization and 6 months after operation. The collected data were analyzed by SPSS 20.0 software. Results: there was no significant difference in clinical baseline between the two groups. The platelet inhibition rate was detected by TEG 3 days after PCI. The platelet inhibition rate was 80.94 卤22.57 in the smoking group and 66.65 卤26.25 in the non-smoking group, which was higher in the smoking group than in the non-smoking group. The difference between the two groups was statistically significant. The platelet inhibition rate was 83.83 卤23.65 in smoking group and 82.97 卤18.93 in non-smoking group. There was no significant difference between the two groups. One month after operation, the thromboelastogram and platelet inhibition rate of ADPI were 81.64 卤20.37 in the smoking group and 69.15 卤22.89 in the non-smoking group, which were still higher than those in the non-smoking group. The difference between the two groups was statistically significant. The platelet inhibition rate was 84.01 卤23.45 in smoking group and 83.18 卤18.43 in non-smoking group. There was no significant difference between the two groups. Within 6 months of follow-up, there were 7 cases of MACE, 3 cases of bleeding, 9 cases of MACE and 4 cases of hemorrhage in smoking group and non-smoking group. There was no significant difference in MACE and bleeding events between the two groups (p 0.05). Conclusion 1. Smoking enhanced the antiplatelet aggregation of clopidogrel 2. During the follow-up period, there was no significant difference in MACE and bleeding events between the two groups. This study failed to prove that smokers were more likely to benefit from clopidogrel than non-smokers.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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