不同强化抗血小板治疗对冠状动脉支架植入后氯吡格雷低反应患者的近期疗效及安全性研究

发布时间：2018-05-22 13:49

本文选题：冠心病 + 氯吡格雷低反应性　；参考：《南京医科大学学报(自然科学版)》2017年06期

【摘要】：目的:研究经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)后氯吡格雷低反应(clopidogrel low response,CLR)患者接受不同强化抗血小板治疗方案的近期疗效及安全性。方法:采用光学血小板聚集仪(light transmittance aggregometer,LTA)筛选PCI术后CLR住院患者150例。将入选者随机分为3组:(1)常规治疗(A)组:服用阿司匹林(100 mg,每天1次)及氯吡格雷(75 mg,每天1次)持续1年;(2)强化治疗(B)组:服用阿司匹林(100 mg,每天1次)及氯吡格雷(150 mg,每天1次)强化1个月后改为上述常规治疗持续1年;(3)强化治疗(C)组:服用阿司匹林(100 mg,每天1次)及替格瑞洛(90 mg,每天2次)强化1个月后改为常规治疗持续1年;于术后1个月复查二磷酸腺苷诱导的血小板聚集率(adenosine diphosphate induced platelet aggregation,PLADP)和花生四烯酸诱导的血小板聚集率(arachidonic acid induced platelet aggregation,PL_(AA)),并随访临床事件发生情况。结果:3组临床资料及理化指标差异均无统计学意义;3组患者治疗前PLADP差异无统计学意义(P=0.553),PL_(AA)差异也无统计学意义(P=0.352);治疗1个月后B组、C组PLADP均显著低于同组基线值(P均0.001),C组PLADP显著低于A、B两组(P均0.001);3组PL_(AA)差异无统计学意义。治疗1个月后随访,A、B、C组支架内血栓、靶血管重建以及心源性再入院的总发生率分别为20%、10%、4%(P=0.039),微小出血发生率分别为10%、14%、28%(P=0.044),C组呼吸困难的发生率为6%,显著高于A、B两组(P=0.01)。结论:氯吡格雷强化治疗、替格瑞洛抗血小板治疗均能改善CLR患者的血小板反应性;替格瑞洛强化治疗增加了微小出血与呼吸困难的发生,同时减少了术后1个月支架内血栓、靶血管重建及心源性再入院的总发生率。
[Abstract]:Objective: to study the short-term efficacy and safety of clopidogrel low response to clopidogrel after percutaneous coronary intervention (percutaneous coronary interventionation). Methods: light transmittance aggregator LTA was used to screen 150 inpatients with CLR after PCI. The participants were randomly divided into 3 groups: group A: aspirin 100 mg (once a day) and clopidogrel 75 mg (once a day) for 1 year) intensive treatment (B) group: aspirin 100 mg, once a day) and chlorine Piegrel 150 mg (once a day) after 1 month was replaced by the above routine therapy for 1 year and 3) intensive therapy (C) group: aspirin 100 mg, once a day) and tigrilodine 90 mg, twice a day) 1 month later. The treatment lasted for 1 year; The platelet aggregation rate induced by adenosine diphosphate induced platelet (PLADP) and arachidonic acid induced platelet aggregation (PLADP) induced by adenosine diphosphate (ADP) and arachidonic acid induced platelet aggregation (PLADP) were examined 1 month after operation, and the clinical events were followed up. Results there was no significant difference in clinical data and physical and chemical indexes between the three groups. There was no significant difference in PLADP before treatment in the three groups. There was no significant difference in PLADP between group B and group C after one month of treatment. The PLADP of group B was significantly lower than that of the baseline value of the same group. PLADP in group C was significantly lower than that in group A (P 0.001), and there was no significant difference between group A and group A (P = 0.001). One month after treatment, the total incidence of stent thrombosis, target vessel reconstruction and cardiogenic readmission in group A, B, C, and B, B, B, C and B, respectively, were 20 1010, 4 and 0.039, respectively, and the incidence of minor hemorrhage was 10141444, respectively. The incidence of dyspnea in group C was 6, which was significantly higher than that in group A B (0.01). Conclusion: clopidogrel intensive therapy and tigrilol antiplatelet therapy can improve platelet reactivity in patients with CLR, tigrilol intensive therapy can increase the occurrence of minor hemorrhage and dyspnea, and decrease the thrombus in stents 1 month after operation. Total incidence of target vessel reconstruction and cardiac readmission.
【作者单位】：南京医科大学第一附属医院心脏科;
【基金】：国家自然科学基金(81170181)
【分类号】：R541.4

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