阿司匹林抵抗与氯吡格雷抵抗的研究进展

目的: 综述近年来国内外学者对阿司匹林抵抗与氯吡格雷抵抗的研究结果,为临床合理用药提供循证依据。方法: 检索国内外的相关文献,进行系统的文献整理和综合分析。结果: 各研究间由于研究对象、研究方案的设计、使用的检测血小板功能的方法及各检测方法对抗血小板药物抵抗的定义不同等,研究结果存在差异。其中与抗血小板药物抵抗相关的可能临床因素包括患者的性别、合并疾病、合并用药、相关实验室检查等,与抗血小板药物抵抗相关的可能分子机制包括与阿司匹林抵抗相关的基因多态性位点(PTGS1和PLA2)和与氯吡格雷抵抗相关的基因多态性位点(ABCB1、CYP2C19、CYP3A4、CYP3A5和P2Y12)。结论: 临床医生可以从临床因素和基因多态性两方面评估患者发生阿司匹林抵抗与氯吡格雷抵抗的风险,并制定合理的给药方案。

Progress of studies on aspirin resistance and clopidogrel resistance

OBJECTIVE To review studies on aspirin resistance and clopidogrel resistance in recent years, and provide evidences for rational use in clinical practice.METHODS A comprehensive analysis was conducted by retrieving related literatures.RESULTS Due to different subjects, these studies had different study designs, methods to detect platelet functions, and definitions of antiplatelet drug resistance, etc., which resulted in different results.For antiplatelet drug resistance, possible related clinical factors included sex, concurrent diseases, combined drugs, relevant laboratory tests, and possible molecular mechanisms included aspirin resistance related polymorphisms (PTGS1 and PLA2) and clopidogrel resistance related polymorphisms (ABCB1, CYP2C19, CYP3A4, CYP3A5 and P2Y12).CONCLUSION Clinical physicians should evaluate risks of aspirin resistance and clopidogrel resistance based on clinical factors and genetic polymorphisms in patients, and develop a rational dosing regimen.