氯吡格雷低反应的危险因素及预后

目的：探讨冠心病患者氯吡格雷低反应的危险因素以及与支架植入术后心血管事件之间的关系。方法：冠心病患者400例，均口服氯吡格雷常规剂量75mg／d治疗3d以上或顿服氯吡格雷负荷量300mg 6h以上。以10μmol／L二磷酸腺苷（adenonisine disphosphate，ADP）为诱导剂，利用比浊法检测血小板聚集率，根据检测结果将患者分为氯吡格雷低反应和氯吡格雷正常反应两组，比较两组临床及生化指标的差异，运用Logistic回归分析进一步探讨氯吡格雷低反应的影响因素。并随访观察两组患者术后9个月的心血管事件，包括围术期心肌梗死、支架内血栓、急性心肌梗死、心因性死亡和卒中。结果：氯毗格雷低反应的发生率为19．8％。氯吡格雷低反应组和氯吡格雷正常反应组血小板聚集率分别为（49±9）％和（18±11）％（P〈0．01）。二元Logistic回归分析显示糖尿病（OR1．954，95％CI1．036—3．683，P〈0．05）、高脂血症（OR1．915，95％CI1．014—3．617，P〈0．05）及血浆纤维蛋白原（OR1．431，95％CI1．089—1．882，P〈0．05）是氯吡格雷低反应的危险因素。随访观察中氯吡格雷低反应组终点事件的发生率显著高于氯吡格雷正常反应组，差异具有统计学意义（20％眠12％，P〈0．05）。结论：糖尿病、高脂血症、血浆纤维蛋白原与既往PCI史是氯吡格雷低反应的影响因素。与氯吡格雷正常反应组相比，氯吡格雷低反应组终点事件的发生率显著增加。

Analysis of risk factors and prognosis of low clopidogrel responsiveness

AIM： To assess the risk factors of low clopidogrel responsiveness in patients with coronary heart disease （CHD） and analyze the relationship between low clopidogrel responsiveness and recurrent cardiovascular events after PCI. METHODS： A total of 400 patients with CHD were assigned to clopidogrel low responder group （ n = 79） and responder group （ n = 321 ） according to the results of ADP （ 10 μmol/L） -induced platelet aggregation. All patients received a conventional dose of clopidogrel for 3 days or more or oral 300 mg loading dose of clopidogrel for at least 6 h. Possible risk factors of low clopidogrel responsiveness were analyzed by single factor analysis and muhifactor gradual logistic regression analysis. All patients were followed for 9 months after PCI and the primary endpoint was perioperative myocardial infarction, stent thrombosis, acute myocardial infarction, cardiac death and stroke. RESULTS： The incidence of low clopidogrel responsiveness was 19. 8%. Platelet aggregation rates were （49 ±9） and （18 ±11 ）, respectively, in the two groups （P 〈 0. 01 ）. Multivariate logistic regression analysis found that low clopidogrel responsiveness was positively correlated with diabetes mellitus （ OR 1. 954, 95% CI 1. 036 - 3.683, P 〈 0. 05 ）, hyperlipidemia （ OR 1. 915, 95% CI 1. 014 - 3.617, P 〈 0.05 ） and plasma fibrinogen （ OR 1. 431, 95% CI 1. 089 - 1. 882, P 〈 0. 05 ）. Cardiovascular events occurred in 16 patients （20%） in the low clopidogrel responsiveness group and 37 patients （12%） in the control group. CONCLUSION： Diabetes mellitus, hyperlipidemia, plasma fibrinogen and the history of prior PCI are the influencing factors of low clopidogrel responsiveness. Low clopidogrel responsiveness increases the incidence of recurrent cardiovascular events.