氯吡格雷抵抗和冠心病患者PCI术后心血管事件的关系

目的：前瞻性研究氯吡格雷抵抗对冠心病患者发生近、中期心血管事件的影响。方法：102例冠心病患者在服用氯吡格雷前及服药后4天取血，利用比浊法测定血小板聚集率（PAR），计算PAR基线值与服药后最大血小板聚集率（MPAR）差值，其差值≤10％为发生氯吡格雷抵抗，氯吡格雷抵抗组24例，非氯吡格雷抵抗组78例。患者住院期间及出院后随访2～12，平均（7．57士2．91）个月，COX回归分析氯吡格雷抵抗对103例冠心病介入治疗后患者近、中期心血管事件的影响。结果：氯吡格雷抵抗组心血管事件的发生率为58．3％，显著高于非抵抗组（16．7％），P〈0．001。COX回归分析发现，氯吡格雷抵抗（RR=70．262，95％CI=0．123～0．558，P=0．001）和冠脉病变程度（RR=1．052，95％CI=1．030～1．075，P〈0．001）是冠心病患者PCI术后近、中期发生心血管事件的独立危险因素。结论：氯吡格雷抵抗、冠脉病变程度重的患者容易于PCI术后近、中期发生心血管事件。

Correlation between clopidogrel resistance and recurrent cardiovascular events in patients with coronary artery disease after PCI

Objective： To analyze some factors predicting recurrent cardiovascular events in the duration of hospital stay and 12-month follow-up after coronary stent implantation. Methods： Platelet aggregates ratio （PAR） was determined by ADP-induced aggregation （%） in 102 patients. PAR of post treated with clopidogreal decrease less than that of before ≤10% was defined as clopidogreal resistance. There were 24 patients in clopidogreal resistance group, and no clopidogreal resistance group had 78 patients. Following up the patients for 2-12 （7. 57±12.91 ） months. The influential factors of recurrent cardiovascular events were evaluated by COX regression. Results： Incidence of recurrent cardiovascular events of clopidogrel resistance group （58.3%） was more than that of no clopidogrel resistanc group （16.7%）, P〈0.01. Clopidogrel resistance （RR=0. 262, P=0. 001 ） and severe coronary artery lesion （RR= 1. 052, P〈0. 001 ） were risk factors for recurrent cardiovascular events. Conclusion： The patients with clopidogrel resistance or severe coronary artery lesion are more able to happen recurrent cardiovascular events after PCI.