摘要
目的探讨急性冠状动脉综合征(ACS)患者对氯吡格雷的反应变异性与再发心血管事件的关系。方法.ACS患者入院第1天或经皮冠状动脉介入术前服用负荷剂量氯吡格雷(300 mg/d),第2天起服用维持剂量(75 mg/d),同时口服阿司匹林(100 mg/d),共服用1年。检测患者服用负荷剂量氯吡格雷前和服用后24 h最大血小板聚集率(MAR)并计算血小板聚集抑制率(IPA)。根据IPA将患者分为对氯吡格雷无反应组、低反应组和反应组。分别在服药第1、3、6、12个月末进行随访,记录患者出现再发心血管事件(包括心血管死亡、急性和亚急性支架血栓、再发ACS和缺血性中风)的情况。用Kaplan-Meier生存分析法比较3组患者再发心血管事件的累积发生率。结果 2009年10月至2013年3月在东南大学附属中大医院心内科住院的190例ACS患者纳入研究,男性111例,女性79例,平均年龄(66.1±7.8)岁。氯吡格雷无反应组53例、低反应组46例、反应组91例。3组患者性别构成、合并危险因素及合并用药的差异均无统计学意义(均P>0.05),氯吡格雷无反应组平均年龄[(69.1±7.8)岁]大于反应组[(64.3±7.4)岁](P<0.05),无反应组1、3、6、12个月再发心血管事件累积发生率[11.3%(6/53)、20.8%(11/53)、22.6%(12/53)、35.8%(19/53)]均明显高于反应组[1.1%(1/91)、1.1%(1/91)、2.2%(2/91)、9.9%(9/91)](均P<0.05)。Kaplan-Meier生存分析显示氯吡格雷无反应组再发心血管事件累积发生率明显高于低反应组(P<0.05)与反应组(P<0.01)。结论 ACS患者对氯吡格雷反应的变异性与再发心血管事件可能有关。对使用氯吡格雷的患者应检测MAR与IPA,以减少或避免发生再发心血管事件。
Objective To explore the relationship between the response variability in patients with acute coronary syndrome （ACS） treated with clopidogrel and the recurrent cardiovascular events. Methods The ACS patients received loading dose of clopidogrel （300 mg,/d） on the first day of hospitalization or before percutaneous coronary intervention, then received maintenance dose of clopidogrel （75 mg/d） from the second day, in addition, all patients received aspirin （ 100 mg/d） for one year. The patients＇ maximal aggregation rate （MAR） and inhibition of platelet aggregation（IPA） were measured before and 24 hours after administration of loading dose of clopidogrel. The patients were divided into non-response to clopidogrel, low-response to clopidogrel, and response to clopidogrel groups according to the IPA. The patients were followed-up at the end of 1, 3, 6, and 12 months after administration, respectively. The situation of recurrent cardiovascular （CV） events including cardiovascular death, acute and subaeute stent thromboses, recurrent acute coronary artery syndrome, and ischemic stroke were recorded. The differences in accumulative incidence of recurrent CV events among the 3 groups were compared by Kaplan-Meier survival analysis. Results A total of 190 patients with ACS who were hospitalized in the Department of Cardiology, Zhongda Hospital, Southeast University from October 2009 to March 2013 were enrolled into thestudy, comprising 111 males and 79 females with an average age of （66.1 ± 7.8 ） years. There were 53, 46, and 91 patients in the non-response to elopidogrel group, the low-response to clopidogrel group, and the response to elopidogrel group, respectively. The differences in the sex composition, combined risk factors, and drug combination among the 3 groups were not significant （ all P 〉 0.05 ）. The average age in the non- response to clopidogrel group [ （69.1 ± 7.8 ） years ] was older than that in the response to clopidogrel group [ （ 64.3 ± 7.4） years ] （P 〈 0.05 ）. The accumulative incidence of recurrent CV events on 1,3, 6, and 12 months in the non-response to clopidogrel group [ 11.3% （6/53） ,20.8% （ 11/53 ） ,22.6% （ 12/53 ） and 35.8% （19/53） were significantly higher than those in the response to clopidogrel group [ 1.1% （ 1/91 ） , 1.1% （ 1/91 ） ,2. 2% （2/91） and 9.9% （9/91） ] （ all P 〈 0.05 ）. The resuhs of Kaplan-Meier survival analysis showed that the accumulative incidence of recurrent CV events in the non-response to clopidogrel group were significantly higher than those in the low-response to elopidogrel group （ P 〈 0.05 ） and the response to clopidogrel group （ P 〈 0.01 ）. Conclusions The response variability to elopidogrel of patient with ACS may be associated with recurrent CV events. The patient who received clopidogrel should be given the examination of MAR and IPA in order to decrease or avoid the recurrent CV events.
出处
《药物不良反应杂志》
CSCD
2014年第1期10-14,共5页
Adverse Drug Reactions Journal
基金
南京市科技发展项目(2011YX007)
