冠心病PCI术后发生氯吡格雷抵抗的影响因素

目的 分析接受经皮冠状动脉介入(PCI)治疗的冠心病患者服用双联抗血小板药物后发生氯吡格雷抵抗的影响因素.方法 181例接受PCI治疗的冠心病患者服用阿司匹林和氯吡格雷双联抗血小板药物治疗,术后3d晨起空腹接受血栓弹力图检查,根据对二磷酸腺苷诱导的血小板聚集抑制率的测定结果分为氯吡格雷抵抗组和氯吡格雷敏感组,比较两组患者的一般临床资料、生化指标和影像学特征,Logistic回归分析氯吡格雷抵抗的独立危险因素.结果 181例患者氯吡格雷抵抗的发生率为33.1％(60/181).两组患者的性别构成比、吸烟史、糖尿病史、空腹血糖、糖化血红蛋白、三酰甘油和心肌肌钙蛋白I(cTnI)的差异均有统计学意义(P＜0.05),两组患者影像学检查各项参数比较差异无统计学意义(P＞0.05).Logistic回归分析结果显示氯吡格雷抵抗的独立危险因素有女性(P=0.004,OR=3.411,95％ CI=1.466～ 7.940)、吸烟史(P=0.033,OR =4.930,95％ CI=1.137 ～21.371)、糖尿病史(P=0.007.OR=3.226,95％ CI=1.378 ～7.551)、高空腹血糖(P =0.028,OR=2.113,95％ CI=1.082 -4.125)、高糖化血红蛋白(P=0.000.OR =3.744,95％ CI=1.868 ～7.505)、高三酰甘油(P=0.019,OR=2.639,95％ CI=1.173 ～5.937)和高cTnI(P=0.000,OR=5.631,95％ CI -2.942 ～ 10.777).结论 女性、糖尿病、吸烟、高血脂和心肌酶增高可能是冠心病患者PCI术后发生氯吡格雷抵抗的危险因素.

Influential factors of clopidogrel resistance in patients with coronary heart disease after percutaneous coronary intervention

Objective To observe the influential factors of clopidogrel resistance in patients with coronary heart disease treated with aspirin and clopidogrel after percutaneous coronary intervention(PCI).Methods A total of 181 patients with coronary heart disease treated with aspirin and clopidogrel after PCI 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 general clinical data,biochemical parameters and imaging characteristics were compared between two groups,and the independent risk factors of clopidogrel resistance were explored by Logistic regression analysis.Results The incidence of clopidogrel resistance after PCI was 33.1%(60/181) in these 181 patients.There were significant differences in gender ratio,history of smoking,history of diabetes,fasting plasma glucose,glycosylated hemoglobin,triglyceride and cardiac troponin(cTnⅠ) between two groups(P<0.05),and there was no significant difference in the imaging characteristics between two groups(P>0.05).Logistic regression analysis revealed that female(P=0.004,OR= 3.411,95%CI=1.466-7.940),history of smoking(P=0.033,OR=4.930,95%CI=1.137-21.371),history of diabetes(P=0.007,OR=3.226,95%CI=1.378-7.551),higher fasting plasma glucose(P=0.028,OR=2.113,95%CI=1.082-4.125),higher glycosylated hemoglobin(P=0.000,OR=3.744,95%CI=1.868-7.505),higher triglyceride(P=0.019,OR=2.639,95%CI=1.173-5.937) and higher cTnⅠ(P=0.000,OR=5.631,95%CI=2.942-10.777)were independent risk factors of clopidogrel resistance.Conclusion Female gender,diabetes,smoking,high blood lipids and myocardial enzyme elevation might be risk factors of clopidogrel resistance in patients with coronary heart disease after PCI.