急性冠脉综合征患者氯吡格雷抵抗与近期疗效的临床观察

目的：检测急性冠脉综合征（acute coronary syndrome，ACS）患者服用氯吡格雷治疗前后腺苷二磷酸（adenosine diphosphate，ADP）诱导的血小板聚集率变化，同时观察临床主要心血管事件发生率。方法：测定88名冠心病稳定型心绞痛患者和102名ACS患者服用氯吡格雷前与服用后第5天ADP诱导的血小板聚集率，按照血小板聚集率的抑制程度分为无反应、低反应和正常反应组。同时观察单纯药物治疗和联合支架置入术治疗患者1月内主要心血管事件发生率。结果：服用氯吡格雷前，ACS患者ADP诱导的血小板聚集率明显高于稳定型心绞痛患者[（80．4±7．8）％US（56．2±12．1）％，P〈0．05]。ACS患者服用氯吡格雷的过程中，无反应患者、低反应患者的发生率分别是21．6％、27．4％。结论：ACS患者呈现出血小板高聚集状态。服用氯吡格雷后血小板聚集率的抑制程度呈现明显个体差异。氯吡格雷无反应和低反应患者在治疗过程中，心绞痛发生率明显高于氯吡格雷正常反应患者（P〈0．05）。联合支架置入术患者心绞痛发生率低于单纯药物治疗患者（P〈0．05）。

Clinical observation of clopidogrel resistance and clinical outcomes on patients with acute coronary syndrome

AIM: To detect ADP ( adenosine diphosphate)-induced platelet aggregation rate of patients with acute coronary syndrome before and after clopidogrel treatment and survey the main cardiovascular events. METHODS: ADP-induced platelet aggregation rates of 88 cases stable angina pectoris patients and 102 cases acute coronary syndrome (ACS) patients were detected before and after 5 days clopidogrel treatment. Patients were divided into three groups: nonresponders, low responders and normal re-sponders according to inhibition degree. The main cardiovascular events were recorded during a month among using simple drug treatment and ACS patients. RESULTS: ADP-induced platelet aggregation rate with ACS patients was much higher than that of patients with stable angina pectoris [ (80.4 ± 7.8) % vs (56.2 ±12.1)%, P < 0.05 ] before clopidogrel treatment. Incidence rates of nonresponders and low responders were 21.6% and 27.4% respectively during using clopidogrel treatment. CONCLUSION: Patients with ACS have a higher platelet aggregation state. Inhibition levels of platelet aggregation rate have significant inter-individual difference after clopidogrel treatment. Incidence rates of diaphragmatic angina in nonresponders and low responders were obviously higher than that in normal responders( P < 0.05) . Incidence rate of angina pectoris using drug-eluting stent implantation was lower than that using simple drug treatment ( P < 0.05).