不同氯吡格雷代谢型急性心肌梗死患者的血小板聚集率变化

目的观察不同氯吡格雷代谢型急性心肌梗死患者使用氯吡格雷后血小板聚集功能的被抑制情况。方法入选2013年3—8月急性心肌梗死患者48例,经过基因检测分为氯吡格雷慢代谢型6例、快代谢型17例和中间代谢型25例。患者均于入病房前服用负荷剂量阿司匹林300 mg和氯吡格雷300 mg,之后阿司匹林100 mg/d和氯吡格雷75 mg/d连续服用,于服药后第6天检测血小板聚集率、血细胞计数、纤维蛋白原含量和肝肾功能。结果所有患者服用氯吡格雷后第6天的血小板聚集率明显下降,二磷酸腺苷、肾上腺素诱导的抑制率分别为74%和84%。氯吡格雷快代谢型、中间代谢型和慢代谢型3组急性心肌梗死患者的二磷酸腺苷诱导的血小板聚集率分别为22.2%±13.4%、32.1%±20.1%和18.6%±13.9%(P>0.05),3组血小板抑制率分别为87%、78%和82%。结论本研究中不同氯吡格雷代谢型急性心肌梗死患者的血小板聚集功能的抑制情况无明显差异。

Inhibition of platelet aggregation of clopidogrei in different clopidogrel metabolizer patients with acute myocardial infarction

Objective To investigate the inhibition of platelet aggregation of clopidogrel in different clopidogrel metabolizer patients with acute myocardial infarction. Methods A total of 48 patients with acute myocardial infarction were enrolled and divided into extensive （ n = 17） , intermediate （ n = 25 ） or poor metabolizer （ n = 6 ）, according to the results of clopidogrel genetic testing. All patients accepted loading dose of aspirin 300 mg and clopidogrel 300 mg at admission, and aspirin 100 mg/d and clopidogrel tablets 75 mg/d continuously. Platelet aggregation, platelet count, fibrinogen levels, liver and kidney function were measured at the 6th day after admission. Results The platelel aggregation rates in all patients were decreased significantly, and ADP, AA-induced platelet inhibition rates were 74% and 84%, respectively. The ADP-induced platelet aggregation rates among three groups （extensive, intermediate and poor metabolizer） were 22.2% ±13.4%, 32. 1% ±20. 1% and 18.6%±13.9% （P〉0.05）, and platelet inhibition rates of three groups were 87%, 78% and 82% （P 〉 0. 05 ）. Conclusions There is no significant difference of platelet aggregation in different clopidogrel metabolizer patients with acute myocardial infarction （extensive, intermediate and poor metabofizer） at the 6th day after admission.