共查询到19条相似文献,搜索用时 140 毫秒
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氯吡格雷是急性冠状动脉综合征、缺血性卒中以及经皮冠状动脉介入治疗、大血管闭塞性卒中血管内治疗术前和术后最常用的抗血小板药,但其抗血小板效果存在个体差异,即存在氯吡格雷抵抗现象(clopidogrel resistance, CR)。CR通常归因于血浆中巯基代谢物浓度的降低,而引起巯基代谢物浓度降低的因素众多。文章对CR... 相似文献
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目的观察冠心病介入治疗患者的氯吡格雷抵抗的发生率及相关因素。方法利用比浊法测定5μmol/L二磷酸腺苷(adenosine diphosphate,ADP)诱导的血小板聚集率(platelet aggregation rate,PAR)来判定是否发生氯吡格雷抵抗,并将研究对象按是否发生抵抗分组,按病例对照研究方法分析相关因素。结果冠心病患者介入治疗后氯吡格雷抵抗的发生率为24.3%。抵抗组与非抵抗组比较发现胰岛素抵抗指数(HOMA-IR,5.3±3.3vs3.5±2.9,P<0.01)、总胆固醇[(5.3±1.6)mmol/Lvs(4.7±1.0)mmol/L,P<0.05)]及冠脉病变程度[(65±53)分vs(31±29)分,P<0.01)]有统计学意义。结论氯吡格雷抵抗的发生率24.3%,胰岛素抵抗、总胆固醇和冠脉病变程度可能是其相关因素。 相似文献
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目的:评估高维持剂量氯吡格雷在氯吡格雷低反应的冠状动脉介入患者中,对血小板聚集反应及临床预后的影响。方法:连续入选我院心内科2010-01-2010-12接受冠状动脉介入患者中氯吡格雷低反应者60例,随机分为维持量150mg组(30例)和75mg组(30例),共服用6个月,测定2组患者1个月和6个月时的血小板聚集性能,并随访临床预后和出血的发生率。结果:在氯吡格雷低反应患者中,应用双倍维持量氯吡格雷能够显著增强对血小板聚集的抑制反应。在150mg组患者中,1个月时有13例(43.3%)最大血小板聚集性回复至50%以下,6个月时有18例(60.0%)最大血小板聚集性回复至50%以下。而在75mg组患者中,1个月及6个月时均无患者血小板聚集性回复至50%以下。在6个月的临床随访中,150mg组患者的复合终点事件发生率明显降低,而出血的发生率无明显增加。结论:对于氯吡格雷低反应患者,增加氯吡格雷维持剂量可能是一个安全有效的解决途径,值得进一步研究。 相似文献
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氯吡格雷是临床常用的抗血小板药物,但近年来的研究发现,部分患者存在氯吡格雷低反应性,也就是氯吡格雷抵抗或氯吡格雷无反应性,即描述服用氯吡格雷而不能提供充分抗血小板作用的一种现象。氯吡格雷低反应者血小板聚集率高,易发生心血管事件。现对目前有关氯吡格雷低反应性的定义、可能发生的机制和解决方法进行综述。 相似文献
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氯吡格雷抵抗的发生率和危险因素分析 总被引:1,自引:0,他引:1
目的 探讨氯吡格雷抵抗(CR)的发生率及其与心血管疾病危险因素的相关性.方法 采用回顾性病例对照研究,根据血小板聚集抑制率(DPAI)及CR将患者分为正常组、半抵抗组和抵抗组,分析年龄、性别、吸烟、饮酒、肥胖、血压、血脂、血糖、尿酸和高敏C反应蛋白等与其的相关性.结果 共调查107例心内科住院患者,平均血小板聚集抑制率(DPAI)(24.4±23.3)%(0~85%),CR的发生率为33.6%.并未发现以上冠心病危险因素与CR存在相关性.结论 本研究中CR发生率较高,常见的危险因素与CR可能无关. 相似文献
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目的:评价不同维持剂量氯吡格雷对直接冠状动脉介入(PPCI)术后发生氯吡格雷抵抗患者的疗效和安全性。方法:回顾性分析2008-01-2011-01因急性心肌梗死(AMI)于我院抢救中心住院行PPCI,术后5d化验检查发现氯吡格雷抵抗的患者277例。所有患者均于术前常规给予口服氯吡格雷负荷剂量300mg、阿司匹林300mg;术后常规给予阿司匹林100mg/d,术后1~4d服用氯吡格雷75mg/d。根据术后第5天起服用氯吡格雷剂量分为75mg/d组(156例)和150mg/d组(121例)。观察2组二磷酸腺苷(ADP)及临床事件发生情况。结果:术后第5天2组ADP值差异无统计学意义(P=0.201);而150mg/d组术后14d(P=0.039)、30d(P=0.038)、90d(P=0.010)和180d(P=0.012)ADP值均显著低于75mg/d组,均差异有统计学意义。术后30d时2组AMI发生率(P=0.634)、病死率(P=0.391)和轻度出血发生率P=0.476)均差异无统计学意义。而在随访180d时150mg/d组AMI发生率(P=0.041)和病死率(P=0.034)均显著低于75mg/d组,均差异有统计学意义;而2组轻度出血发生率(P=0.371)差异无统计学意义。随访过程中2组均无中、重度出血发生。Logis-tic回归分析结果显示,应用氯吡格雷150mg/d是180d时发生AMI(OR=1.236,95%CI:0.567~2.071,P=0.023)的独立影响因素,但不是180d时病死率(OR=0.522,95%CI:0.218~1.369,P=0.224)的独立影响因素。结论:对PPCI术后发生氯吡格雷抵抗的患者,增加氯吡格雷维持量能进一步抑制血小板功能,进而减少临床不良事件的发生率,而且安全性良好。 相似文献
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氯吡格雷抵抗的发生率及其影响因素 总被引:3,自引:0,他引:3
氯吡格雷广泛应用于急性冠脉综合征及行经皮冠状动脉介入治疗的患者,但个体之间对氯吡格雷的反应各不相同,部分病人对氯吡格雷反应较差甚至无反应。就氯吡格雷抵抗的发生率、影响因素作一综述。 相似文献
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卢云飞 《心血管康复医学杂志》2013,(2):180-182
目的:探讨氯吡格雷对急性冠脉综合征(ACS)患者炎性标记物的影响。方法:入选在我院住院治疗的ACS患者158例,其中不稳定型心绞痛患者67例、非ST段抬高型心肌梗死患者42例、ST段抬高型心肌梗死49例。根据临床用药方式的不同所有患者被分为联合治疗组(80例,氯吡格雷+阿司匹林)和阿司匹林治疗组(78例,阿司匹林),检测两组患者治疗前,治疗后第7、14d血清高敏C-反应蛋白(hsCRP)、P-选择素(P-selec-tin)、白细胞介素-6(IL-6)水平。结果:治疗第7d,两组患者hsCRP、IL-6以及P-选择素均较治疗前显著升高(P<0.05);阿司匹林治疗组上升幅度显著高于联合治疗组(P<0.05);治疗第14d,两组患者上述指标均较治疗前显著降低(P<0.01),与阿司匹林组比较,联合治疗组hsCRP[(3.48±1.98)mg/L比(2.93±1.16)mg/L]、IL-6[(9.81±4.58)μg/L比(8.98±3.52)μg/L]、P-选择素[(9.56±4.67)ng/ml比(9.11±4.57)ng/ml]水平降低更显著(P均<0.05)。两组患者出血情况差异无显著性(P>0.05)。结论:氯吡格雷能显著降低急性冠脉综合征患者炎性标志物水平,这可能是其发挥作用的机制之一。 相似文献
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目的 探讨老年急性冠脉综合征(ACS)患者传统危险因素与非传统危险因素特点及其与预后关系的分析. 方法 回顾性分析ACS患者216例,按年龄分为老年组(≥60岁)和非老年组,统计分析2组危险因素个数分布特点及其与预后之间的相关性.传统因素包括性别、低密度脂蛋白胆固醇(LDL-C)>1.8 mmol/L、高密度脂蛋白胆固醇(HDL-C)<1.0 mmol/L、高血压、糖尿病、吸烟,非传统因素包括三酰甘油(TG)> 1.7 mmol/L、C反应蛋白(CRP) >2 mg/L、前驱糖尿病[空腹血糖5.6~7.0 mmol/L或者糖化血红蛋白(HbA1c) >6%]、体质量指数(BMI) >25. 培果 与非老年组比较,老年组具有的危险因素个数增多(P<0.05),其中老年组中LDL-C> 1.8mmol/L、HDL-C< 1.0 mmol/L、高血压、糖尿病、CRP>2 mg/L、前驱糖尿病的比例较非老年组高(P<0.05);而吸烟、TG> 150 mg/dl、超重的发生率在非老年组较高(P<0.05);ACS老年患者6月主要心脑血管事件(MACCE)发生率随着危险因素个数增多逐渐增高. 结论 老年ACS患者具有的危险因素个数多,且分布特点与非老年人群不同;随着危险因素个数增加,老年患者发生心脑血管意外的风险相应增加. 相似文献
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目的: 探讨60岁以上老年冠心病患者行冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后氯吡格雷抵抗的发生率和影响因素。方法: 符合入选标准的患者208例,年龄61~80岁,根据对氯吡格雷的反应分为氯吡格雷抵抗组55例和氯吡格雷有反应组153例。 结果: 氯吡格雷抵抗的发生率26.4%。氯吡格雷抵抗组和有反应组血小板聚集率(platelet aggregation rate,PAR)分别为(57±6)%和(35±9)%(P<0.01)。多因素logistic回归分析提示Ⅱ型糖尿病[P=0.037, 优势比(OR)=2.053,95%置信区间1.045-4.034]是氯吡格雷抵抗的影响因素。结论: 60岁以上老年冠心病患者PCI术后氯吡格雷抵抗的发生率26.4%,Ⅱ型糖尿病是氯吡格雷抵抗的影响因素。 相似文献
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脂联素与冠心病类型和心血管危险因素的关系 总被引:1,自引:1,他引:0
目的:明确冠心病(CHD)患者脂联素(APN)水平是否下降,确定低APN血症是否是CHD的危险因素及APN水平与CHD类型和心血管危险因素间的关系。方法:117例研究对象分为对照组(CO)、稳定型心绞痛组(SAP)和急性冠状动脉综合征(ACS)组。SAP、ACS组与CO组进行比较了解CHD患者APN水平;比较不同类型患者的APN水平以确定APN水平与CHD类型间的关系;经logistic回归分析确定低APN血症是否是CHD的危险因素;比较合并某一心血管危险因素者与不合并者的APN水平,了解心血管危险因素对APN水平的影响。结果:CO组、SAP组、ACS组3组比较APN呈降低趋势(10.61±3.38,6.98±3.18,4.59±3.69,P0.05);逐步logistic回归分析结果显示低APN血症(OR值=0.788,p=0.041)、高胆固醇血症(OR值=5.096,p=0.009)为CHD患病的独立危险因素;超重或肥胖、血脂异常、男性、吸烟、合并3个及3个以上危险因素的CHD患者APN水平降低(P0.05),合并高血压和糖尿病者APN水平无明显下降。结论:CHD患者APN水平下降,ACS患者APN水平较SAP患者进一步下降。低APN血症是CHD的危险因素。肥胖、吸烟、男性、血脂异常可使APN水平下降,且合并心血管危险因素多者APN水平进一步降低。 相似文献
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Background: In patients with coronary artery disease (CAD), the site and extent of coronary artery involvement in terms of proximal versus distal stenosis and multi- versus single-vessel disease have a crucial effect on patients' outcome. This study was designed to evaluate the relationship between cardiovascular risk factors and the site and extent of coronary artery involvement. Methods: In this study of patients who had undergone coronary angiography in our hospital, 125 with proximal lesions were enrolled as the case group (group 1) and an equal age- and gender-matched number of patients with non-proximal lesions were selected as the control group (group 2). The two groups were compared based on the presence or absence of diabetes mellitus (DM), hypercholesterolaemia, hypertriglyceridaemia, hypertension (HTN) and cigarette smoking. Results: The frequency of DM was 33.6 and 10.4% in the case and control groups, respectively, which was statistically significant (p < 0.0001). However, the frequency of hypercholesterolaemia in the case and control groups was 30.4 and 29.6% (p = 0.89), respectively; for hypertriglyceridaemia it was 19.2 and 16.8% (p = 0.062), respectively; for HTN it was 33.6 and 28.8% (p = 0.4), respectively; and for cigarette smoking it was 28.8 and 39.2% (p = 0.08), respectively, which were not statistically significant. Diabetic patients compared to non-diabetics had more multi-vessel disease (89.1 vs 61%, p < 0.0001, respectively), which was statistically significant. There was no relationship between hypercholesterolaemia, hypertriglyceridaemia, HTN and cigarette smoking and extent (multi-vessel involvement) of CAD (p = NS). Conclusion: Proximal and multi-vessel involvement of the coronary arteries in patients with CAD was related to a history of DM but not of hypercholesterolaemia, HTN, cigarette smoking and hypertiglyceridaemia. 相似文献
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目的评价联合应用氯吡格雷治疗非ST段抬高的心肌梗死的疗效。方法60名诊断为急性非ST段抬高的心肌梗死患者随机分为3组,标准治疗组(对照组)、联合氯吡格雷1个月组(1个月组)、联合氯吡格雷6个月组(6个月组),观察指标为半年内发生的心血管事件。结果对照组13名(65%)、1个月组6名(30%)、6个月组1名(5%)发生心血管事件。1月组分别与对照组,6月组比较均P<0.05。结论标准治疗联合应用氯吡格雷治疗急性非ST段抬高的心肌梗死,可有效地预防心血管事件,而且联合应用6个月比1个月治疗效果更明显。 相似文献
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Jane A. Lee Gwen Yeo Dolores Gallagher-Thompson 《Journal of cross-cultural gerontology》1993,8(1):17-33
The leading cause of death among the aging population is cardiovascular disease. Cardiovascular disease prevention and modification of disease risk factors are important and worthwhile directions for study because this population is rapidly increasing. Past studies have shown the significance of modifying cardiovascular disease risk factors in Anglo populations where major risk factors of hypertension, elevated cholesterol levels, diabetes, obesity, physical inactivity and smoking have been identified. However, the prevalence of these risk factors and the attitudes towards modifying them have not been studied in the Korean-American elderly population. This preliminary study used questionnaires given to fifty older recently immigrated Korean-American participants of a Korean senior center. Results show that this population has a lower frequency of cardiovascular disease and all risk factors, except for diabetes compared to an Anglo elderly population In addition, older Korean-American elders were generally unaware of risk factors for cardiovascular disease and uninterested in changing their habits to avoid cardiovascular disease. Increased availability of educational campaigns and health care in Korean are recommended. 相似文献
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目的:探讨编码CYP2C19酶的基因(CYP2C19)功能缺失性(LOF)等位基因与老年冠心病患者支架植入术后氯吡格雷抗血小板反应性和临床心血管终点事件的关联性。方法连续募集2011年9月1日至2012年12月1日期间在解放军总医院住院拟行经皮冠状动脉介入术(PCI)、年龄≥65岁的老年冠心病患者,术前给予氯吡格雷负荷剂量(300mg)治疗,手术当日测定血小板聚集率,采用SNaPshot法进行CYP2C19 LOF等位基因型(CYP2C19*2和CYP2C19*3)检测,并记录在院临床资料。所有患者均在PCI术后1年规律服用阿司匹林和氯吡格雷,随访1年内主要心血管缺血和出血事件的发生率。结果在436例符合入选标准的老年冠心病患者中,CYP2C19*2携带者与氯吡格雷负荷剂量治疗后的抗血小板反应性之间存在显著相关性(P=0.001),但在CYP2C19*3携带者中未见上述相关性(P=0.884)。CYP2C19*2和至少一个CYP2C19 LOF携带者1年内心血管终点事件的发生率较非携带者均明显增加(P<0.05)。与非携带者相比,CYP2C19*2携带者因心绞痛再入院的发生率明显增加[校正比值比(OR):1.67,95%可信区间(CI):1.05~2.65,P=0.010]。至少一个CYP2C19 LOF携带者的联合心血管事件(校正OR:1.22,95%CI:1.03~1.98,P=0.049)和因心绞痛再入院(校正OR:1.67,95%CI:1.04~2.68,P=0.032)的发生率较非携带者明显增加。结论 CYP2C19 LOF等位基因与老年冠心病患者PCI术后的氯吡格雷抗血小板反应性密切相关,并可明显削弱PCI术后双联抗血小板的治疗效果,导致PCI术后1年内的心血管终点事件发生风险明显增加。 相似文献
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Heart failure in the general population of men--morbidity, risk factors and prognosis 总被引:2,自引:0,他引:2
AIMS: To analyse the prevalence, aetiology and prognosis of heart failure. METHODS AND RESULTS: A random population sample of men (n=7495) was examined at baseline in 1970-73 and followed until 1996. During up to 27 years, 937 men were hospitalized for heart failure. For the statistical analysis, odds ratios and 95% confidence intervals, multivariate logistic regression and time-dependent Cox analysis were used. The incidence rate was 2.1, 9.1 and 11.5 per 1000 person-years in the age groups 55-64, 65-74 and 75-79, and the prevalences were 0.6, 2.8 and 6.2%, respectively. Valvular heart disease was the aetiology in 5.8%, coronary heart disease only or in combination with hypertension in 58.8%, and hypertension only in 20.3%, and various combinations with diabetes in 4.5%. Of the remaining 12.1%, 96% were smokers and 64% were registered for alcohol abuse. Risk factors were increasing age, myocardial infarction in the family, diabetes mellitus, chest pain, tobacco smoking, high coffee consumption, alcohol abuse, high body mass index, high blood pressure as well as treatment for hypertension, but not high total cholesterol or psychological stress. Mortality after the diagnosis was increased eight times. CONCLUSIONS: Coronary heart disease and hypertension were the most common concomitant diseases. Risk factors were similar to those in coronary heart disease, and also alcohol abuse, but not high total cholesterol, low physical activity or psychological stress. Mortality was high. 相似文献