急性冠脉综合征患者PCI术后氯吡格雷抵抗的危险因素分析

目的:观察冠心病急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后氯吡格雷抵抗(CR)的危险因素。方法:分析102例入新华医院心内科行PCI治疗的冠心病ACS患者的临床资料。根据血小板抑制情况(血栓弹力图中ADP诱导的血小板聚集率的抑制率),患者被分为CR组(抑制率<30%,39例)和非CR组(抑制率≥30%,63例)。对CR的可能危险因素进行单因素分析和多因素逐步Logistic回归分析。结果:102例中39例出现CR,发生率为38.2%;与非CR组比较,CR组糖尿病患者比例(15.9%比33.3%)、白细胞计数[(6.34±1.98)×109/L比(7.38±2.42)×109/L]明显升高(P<0.05);进一步Logistic回归分析发现,2型糖尿病(B=1.470,P=0.008)和白细胞计数(B=0.331,P=0.008)是该类患者发生CR的独立危险因素。结论:2型糖尿病和白细胞计数升高是氯吡格雷抵抗的独立危险因素。

Analysis of risk factors for clopidogrel resistance in patients with acute coronary syndrome after percu- taneous coronary intervention

Objective： To study risk factors for clopidogrel resistance （CR） in patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）. Methods： Clinical data of 102 ACS patients, who under-went PCI in department of cardiology of Xinhua hospital, were analyzed. According to platelet inhibition condition （ADP inducing inhibition rate of platelet aggregation rate in thrombelastogram）, patients were divided into CR group （inhibition rate.≥30%, n = 39） and non-CR group （inhibition rate ≥30%, n = 63）. Possible risk factors of CR were analyzed by single factor analysis and multi-factor gradual Logistic regression analysis. Results.. A total of 39 patients occurred CR among the 102 patients and its incidence rate was 38. 2% ; compared with non-CR group, there were significant increase in percentage of patients with diabetes mellitus （15.9% vs. 33. 3%） and white blood cell count [ （6.34 ±1.98） 10^9/L vs. （7.38 ± 2.42） 10^9/L] in CR group, P〈0.05 both; Further Logistic regression analysis found that type 2 diabetes mellitus （B = 1. 470, P = 0. 008） and white blood cell count （B = 0. 331, P = 0. 008） were independent risk factors for CR occurrence in these patients. Conclusion： Both diabetes mellitus type 2 and increased white blood cell count are independent risk factors of clopidogrel resistance.