老年冠心病患者氯吡格雷抵抗的影响因素研究

目的研究老年冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入术(PCI)后氯吡格雷抵抗的影响因素。方法将2009年1月至2012年12月间福建医科大学附属龙岩第一医院收治的146例老年冠心病患者根据血栓弹力图检测结果分为抵抗组和敏感组,均使用氯吡格雷抗血小板治疗,分析造成氯吡格雷抵抗的影响因素。结果 Logistic回归分析结果显示氯吡格雷抵抗的独立危险因素有性别(OR=3.462,95%CI 1.415⁷.962),吸烟史(OR=4.941,95%CI 1.2457.962),吸烟史(OR=4.941,95%CI 1.245²1.762),糖尿病史(OR=3.253,95%CI 1.37421.762),糖尿病史(OR=3.253,95%CI 1.374⁷.592),空腹血糖(OR=2.176,95%CI 1.0737.592),空腹血糖(OR=2.176,95%CI 1.073⁴.632),糖化血红蛋白(OR=3.715,95%CI 1.8264.632),糖化血红蛋白(OR=3.715,95%CI 1.826⁷.472),肌钙蛋白(OR=5.642,95%CI 2.9347.472),肌钙蛋白(OR=5.642,95%CI 2.934⁹.758),三酰甘油≥2.26(OR=2.694,95%CI 1.6349.758),三酰甘油≥2.26(OR=2.694,95%CI 1.634⁴.938)。结论性别因素、行为因素以及生化因素是造成氯吡格雷抵抗的主要原因,需要采取差异化抗凝治疗。

The Prevalence and Influential Factors of Clopidogrel Resistance of Elderly Patients with Coronary Heart Disease

Objective To investigate the prevalence and influential factors of cIopidogrel resistance of elderly patients with coronary heart disease. Methods A total of 146 patients with coronary heart disease treated with aspirin and clopidogrel after pereutaneous coronary intervention （PCI） from Longyan First Hospital Affiliated to Fujian Medical University from jan. 2009 to Dec. 2012 were enrolled, and were examined with fasting thrombelastography 3 d after PCT. Patients were divided into clopidogrel resistance group and clopidogrel sensitive group according to adenosine diphosphate-induced platelet aggregation inhibition rate. The imaging characteristics, biochemical parameters and general clinical data, were compared between the two groups, and the independent risk factors of clopidogrel resistance were explored by Logistic regression analysis. Results Logistic regression analysis revealed that female （ OR = 3. 462,95 % CI 1.415-7. 962 ）, histar of smoking （ OR = 4. 941,95 % CI 1. 245-21. 762）, history of diabetes （ OR = 3. 253,95 % CI 1. 374-7. 592 ） fasting blood-glucose ≥ 11.1 mmol/L（ OR = 2. 176,95 % CI 1. 073-4. 632 ）, glycosylated hemoglobin （ OR = 3. 715,95% CI 1. 826-7. 472 ）, troponin （ OR = 5. 642,95% CI 2. 934-9. 758 ） and triaeylglycerol ≥ 2.26 （ OR = 2,694,95% CI 1. 634-4.938 ） were independent risk factors of elopidogrel resistance. Conclusion Gender, behavioral and biochemical factors are the main causes of clopidogrel resistance, and differential anticoagulation therapy should be adopted.