三联抗血小板治疗在氯吡格雷抵抗患者行冠脉介入治疗中的疗效与安全性研究

目的本研究通过观察经皮冠状动脉介入术（PCI）患者血管舒张剂刺激磷蛋白（VASP）磷酸化（VASP-P）程度、血小板α颗粒糖蛋白（CD62P）的变化规律,探讨三联抗血小板治疗在氯吡格雷抵抗患者（Clopidogrel resistance,CR）行PCI治疗中的疗效与安全性。方法选择行冠状动脉支架术的患者201例,随机分为标准组（n=100）及优化组（n=100）。标准组给予标准抗血小板治疗,优化组患者术中给予替罗非班持续泵入36～72 h,其后氯吡格雷改为150 mg/d。另外选择30例健康者作为正常对照组。观察VASP-P、CD62P、血小板反应性指数（PRI）及住院期间主要心血管不良事件（MACE）及出血发生率等指标。结果标准组及优化组CR患者药物治疗后的CD62P和PRI均较治疗前明显下降,差异均有统计学意义（均P〈0.05）;优化组CR患者PCI术后36 h的CD62P和PRI较术前显著降低,差异均有统计学意义（均P〈0.05）。患者PCI术后住院期间主要心血管事件（MACE）发生率,优化组低于标准组,差异有统计学意义（P〈0.05）;出血发生率两组比较差异无统计学意义（P〉0.05）。结论在两联抗血小板治疗基础上加用盐酸替罗非班可进一步抑制患者的血小板聚集功能。

Research of the efficacy and safeness of triple antiplatelet therapy in patients with Clopidogrel resistance combined with coronary heart disease after percutaneous coronary intervention

Objective To investigate the efficacy and safeness of triple antiplatelet therapy in patients with Clopidogrel re sistance（CR） combined with coronary heart disease after percutaneous coronary intervention（PCI） by observing the change rules of the VASP phosphorylation（VASP-P） and CD62P.Methods 201 patients with coronary stenting were enrolled and randomly assigned to optimal group（n=101） and standard group（n=100）,patients in standard group were treated with standard antiplatelet therapy,patients in optimal group were pumped into Tirofiban continuously for 36-72 hours,then Clopidogrel were applied for 150 mg/d.30 healthy adults were selected as control group.VASP-P,CD62P,PRI,MACE and the incidence rate of haemorrhage were observed.Results CD62P and PRI in optimal group and standard group after pharmacotherapy were lower than those before the drug therapy,the differences were all statistically significant（all P0.05）;CD62P and PRI of CR patients in optimal group 36 hours after PCI were lower than those before PCI,the differ ences were all statistically significant（all P0.05）.Incidence rate of MACE after PCI in optimal group was lower than that in standard group,the difference was statistically significant（P0.05）;the difference of the incidence rate of haemorrhage in the two groups was not statistically significant（P0.05）.Conclusion The two united standard antiplatelet therapy combined with Tirofiban can inhibit the aggregation function of the platelet activity.