不同维持剂量氯吡格雷对急性冠脉综合征介入治疗术后血小板功能的影响

目的探讨不同维持剂量氯吡格雷在不同时间点对高危急性冠脉综合征（ACS）患者支架术后血小板功能的影响。方法选取60例行药物洗脱支架（DES）植入术的ACS高危患者，随机分为A、B2组（各30例）。术前2组均服用阿司匹林100mg和氯吡格雷600mg，术后在服用阿司匹林基础上，A、B组分别给予氯吡格雷150、75mg／d治疗30d．30d后所有患者接受75mg／d氯吡格雷治疗直至术后1年。分别于服药前，术后第1、2、7、30天采2组患者静脉血，采用比浊法测定血小板聚集率（PA），同时监测血小板聚集抑制率（PAI）；酶联免疫法测定血浆可溶性P选择素（sP—s）浓度。术后随访3个月，观察2组终点事件发生情况。结果术前和术后第1天2组PA、PAI和sP—S浓度比较无显著性差异（P〉0．05；而术后第2、7、30天上述指标2组间比较均有显著性差异（P〈0．05）。2组组内不同时间点PA、PAI和sP—S比较均有显著性差异（P〈0．05）。随访3个月，A组主要终点事件发生率明显低于B组（13．33％VS3．33％，P〈0．05），次要终点事件发生率无显著性差异（P〉0．05）。结论经皮冠状动脉介入（PCI）术后，150mg／d维持量氯吡格雷可降低ACS行DES植入术后血小板聚集功能，减少术后近期发生不良事件的风险，且不增加出血事件的发生。

Effect of Different Maintenance Dose of Clopidogrel on Platelet Function in Patients with Acute Coronary Symptom Undergoing Percutaneous Coronary Intervention

Objective To investigate the platelet agregation effects with different doses of clo- Pidogrel in high-risk patients with acute coronary symptom undergoing pereutaneous coronary intervention. Methods Sixty high-risk ACS patients undergoing drug-eluting stent （DES） implantation were randomly divided into groups A and B （30 cases in each group）. Oral aspirin 100 mg and elopidogrel 600 mg before PCI,based on taking aspirin,elopidogrel were given 75 mg/d or 150 mg/d for 30 days after PCI. After 30 day all patients received clopidogrel 75 mg/d until 1 year after PCI. Respectively,before administration and 1 day, 2 day, 7 day, 30 day after PCI, peripheral venous blood was collected to determine platelet aggregation （PA） with turhidimetric method and determine plasma soluble P-selectin （sP-s） concentrations with enzyme-linked immunosorbent assay. At same time platelet aggregation inhibition rate （PAl） was calculated. Primary endpoint ineluded death, target organ revaseularization. Secondary endpoints included serious and minor bleeding events. Results Before administration and 1 day after PCI,PA,PAI and the sP-s density had the non-significance difference （P〉0.05） between two groups,and at 2 day,7 day,30 day after PCI three indexes between two groups were a significant different （P〈0.05）. At different time points in each group three indexes compared with more significant difference（P〈0.05）. Via three months follow-up,the incidence of primary endpoint in 150 mg/d group was obviously lower than that in 75 mg group（13. 33% vs 3. 33%,P〈0. 05）, less increase in sub-end events（P〉 0.05）. Conclusion Platelet aggregation and the risk of adverse events could be reduced in highrisk patients used 150 mg/d maintenance dose clopidogrel undergoing percutaneous coronary intervention,And no increase the incidence of bleeding.