急性冠状动脉综合征冠状动脉支架术后应用他汀类药物对氯吡格雷抗血小板作用无影响

目的探讨急性冠状动脉综合征（ACS）患者行冠状动脉支架术后服用阿托伐他汀或普伐他汀对氯吡格雷抗血小板作用的影响。方法研究对象为150例2006年4至12月成功实施冠状动脉支架术的住院ACS患者,术后第1天起随机接受阿托伐他汀20mg／d（n=50）、普伐他汀20mg／d（／7,=50）或无他汀（n=50）治疗。围术期抗血小板治疗为阿司匹林300mg／d,当天氯吡格雷负荷量300mg,继以维持量75mg／d。观测各组患者术后第1天（基线值）及第3天的血小板膜糖蛋白P-选择素（CD62P）、血小板活化复合物（PAC-1）表达及20μmol／L二磷酸腺苷（ADP）诱导的血小板最大聚集率（MPAR）。结果三组患者临床及CD62P、PAC-1和MPAR的基线值差异均无统计学意义。各观测指标第二次测定值与基线值的差值显示,阿托伐他汀、普伐他汀和无他汀组的ACD62P（4．69±16．78）％、（1．35±10．86）％和（2．97±10．21）％]、APAC-1（12．78±22．07）％、（8．01±21．23）％和（10．65±21．39）％l及AMPAR（5．44±18．68）％、（7．15±19．59）％和（3．76±23．42）％]差异均无统计学意义（P〉0．05）。急性心肌梗死患者亚组分析结果表明,ACD62P（7．50±19．35）％、（3．24±11．18）％和（2．53±8．87）％]、APAC-1（13．40±24．62）％、（11．28±19．90）％和（10．11±21．29）％]及AMPAR（7．56±19．11）％、（7．87±23．60）％和（6．75±23．30）％]三组间差异亦均无统计学意义（P〉0．05）。结论接受冠状动脉支架术的ACS患者服用阿托伐他汀或普伐他汀后,短期内未发现对氯吡格雷的抗血小板作用产生显著影响。

The antiplatelet effect of clopidogrel is not attenuated by statin treatment in patients with acute coronary syndromes undergone coronary stenting

OBJECTIVE: To evaluate the interaction of atorvastatin or pravastatin with clopidogrel on platelet activation and aggregation function in patients with acute coronary syndromes (ACS) undergoing coronary stenting. METHODS: Between April and December 2006, a total of 150 hospitalized ACS patients undergoing coronary stenting were randomized to receive atorvastatin (n = 50), pravastatin (n = 50) or no statin (n = 50) one day post procedure. All patients received standard antiplatelet treatment including aspirin 300 mg/d and loading dose 300 mg of clopidogrel followed by maintenance dose 75 mg/d. The expressions of CD62P and PAC-1 and the maximal platelet aggregation rate (MPAR) induced by 20 micromol/L ADP were measured at day 1 before statin therapy (baseline) and day 3 after procedure. RESULTS: Baseline clinical characteristics and levels of CD62P, PAC-1 and MPAR at the baseline were comparable among three groups. After 3-day statin treatment, the changes of CD62P (4.69 +/- 16.78)% vs. (1.35 +/- 10.86)% vs. (2.97 +/- 10.21)%], PAC-1 (12.78 +/- 22.07)% vs. (8.01 +/- 21.23)% vs. (10.65 +/- 21.39)%] and MPAR (5.44 +/- 18.68)% vs. (7.15 +/- 19.59)% vs. (3.76 +/- 23.42)%] among three groups were not significantly different (all P > 0.05). Subgroup analysis showed that DeltaCD62P (7.50 +/- 19.35)% vs. (3.24 +/- 11.18)% vs. (2.53 +/- 8.87)%], DeltaPAC-1 (13.40 +/- 24.62)% vs. (11.28 +/- 19.90)% vs. (10.11 +/- 21.29)%] and DeltaMPAR (7.56 +/- 19.11)% vs. (7.87 +/- 23.60)% vs. (6.75 +/- 23.30)%] in ACS patients were also similar among three groups (all P > 0.05). CONCLUSION: Neither atorvastatin nor pravastatin attenuates the antiplatelet function of clopidogrel in ACS patients early post coronary stenting.