冠心病患者介入治疗后氯吡格雷抵抗的发生率及相关因素.pdfVIP

心脏杂志 (Chin Heart J)2008，20(3) ·313· · 临床研究· 冠心病患者介入治疗后氯吡格雷抵抗的发生率及相关因素 白艳艳 ，王长谦 ，周明成 ，黄红漫 (1．上海市市东医院心内科，上海200438；2．上海交通大学附属新华医院心内科，上海200092) 摘要：目的 观察冠心病介入治疗患者的氯吡格雷抵抗的发生率及相关因素。方法 利用比浊法测定5~mol／L 二磷酸腺苷(adenosine diphosphate，ADP)诱导的血小板聚集率(platelet aggregation rate，PAR)来判定是否发生氯吡 格雷抵抗，并将研究对象按是否发生抵抗分组，按病例对照研究方法分析相关因素。结果 冠心病患者介入治疗 后氯吡格雷抵抗的发生率为24．3％。抵抗组与非抵抗组比较发现胰岛素抵抗指数(HOMA—IR，5．3±3．3傩3．5± 2．9，P0．o1)、总胆固醇[(5．3±1．6)mmol／L (4．7±1．0)mmol／L，P0．05)]及冠脉病变程度[(65 4-53)分 (31±29)分，P0．01)]有统计学意义。结论 氯吡格雷抵抗的发生率24．3％，胰岛素抵抗、总胆固醇和冠脉病变 程度可能是其相关因素。 关键词：冠状动脉疾病；氯吡格雷抵抗；危险因素 中图分类号：R541．4 文献标识码：A 文章编号：1009-7236(2008)03—313—03 Prevalence and relative factors of clopidogrel resistance in patients under- going coronary stenting BAI Yan—yan ，WANG Chang—qian ，ZHOU Ming—cheng ，HUANG Hong．man (1．Department of Cardiology，Shanghai Shidong Hospital，Shanghai 200438，China；2．Department of Cardiology，Xinhua Hospital Affiliated to School of Medicine，Shanghai Jiaotong University，Shanghai， 200092，China) Abstract：AIM To assess the incidence of clopidogrel resistance in patients undergoing coronary stenting and to exolore the relative factors．METHODS Platelet reactivity was measured by 5 Ixmol／L ADP— induced aggregation(％)in patients undergoing coronary stenting to determine the clopidogrel resist— ance．The subjects with resistance and without resistance were assigned to different groups and correlation factors were analyzed and compared between the 2 groups．RESULTS The incidence of clopidogrel resistance was 24．3％．The HOMA—IR．total cholesterol and coronary artery pathological degree were sig— nificantly different between the two groups(P0．01)．CONCLUSION The incidence of clopidogrel resistance is 24．3％ and insulin resistance．total cholesterol and corona