阿司匹林或氯吡格雷抵抗对急性冠状动脉综合征老年患者心血管不良事件的影响被引量：29

Impact of Aspirin or Clopidogrel Resistance on Major Adverse Cardiovascular Events in Elderly Patients With Acute Coronary Syndrome

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摘要目的:分析抗血小板药物抵抗对急性冠状动脉综合征(ACS)老年患者主要心血管不良事件(MACE)的影响,并探讨血栓弹力图(TEG)在抗血小板治疗中的应用价值。方法:纳入2012-09至2014-12在胜利油田中心医院保健内科住院的ACS患者177例,平均年龄(70.4±10.7)岁,均进行TEG及凝血功能检测,根据抗血小板治疗反应性分为非抵抗组(n=98)和抵抗组(n=79);抵抗组再按随机数字表法随机分为维持剂量亚组(n=39)和增大剂量亚组(n=40)。随访3个月内MACE(包括心血管死亡、再发心绞痛、缺血性脑卒中、心肌梗死、急性血栓形成及出血并发症)的发生情况。结果:抵抗组中阿司匹林抵抗的发生率为63.3%(50/79),氯吡格雷抵抗的发生率为36.7%(29/79)。与非抵抗组相比,抵抗组凝血反应时间、血凝块成形时间、描记图最大幅度(MA)后30 min振幅减少百分率、活化部分凝血活酶时间、凝血酶时间、国际标准化比值水平均显著降低(P<0.05),描记图最大曲线弧度作切线与水平线的夹角、MA、凝血指数、纤维蛋白原(FIB)、D-二聚体水平显著增高(P<0.05)。与非抵抗组比较,抵抗组患者3个月内MACE发生率显著增高(21.5%vs 7.1%,P<0.05),而增大剂量亚组较维持剂量亚组的MACE发生率显著降低(17.5 vs25.6%,P<0.05)。结论:抗血小板药抵抗发生MACE的风险较高。TEG检测有助于指导ACS老年患者的抗血小板用药,降低MACE的发生。 Objective： To investigate the impact of clopidogrel or aspirin resistance on major adverse cardiovascular events （MACE） in elderly patients with acute coronary syndrome （ACS） and to explore the application value of thromboelastogram （TEG） in antiplatelet therapy. Methods： A total of 177 ACS patients admitted in our hospital from 2012-09 to 2014-12 were enrolled. The patients were at the mean age of （70.4±10.7） years, all of them received TEG and coagulation function test. Based on the reaction of antiplatelet therapy, they were divided into 2 groups： Non-resistance group,n=98 and Resistance group,n=70, which was further divided into 2 subgroups as Maintenance dose subgroup,n=39 and Increased dose subgroup,n=40. The patients were followed-up for 3 months to observe MACE occurrence including cardiovascular death, angina recurrence, ischemic stroke, myocardial infarction, acute thrombosis and hemorrhage. Results： In Resistance group, there were 50/79 （63.3%） patients with aspirin resistance and 29 （36.7%） with clopidogrel resistance. Compared with Non-resistance group, Resistance group showed decreased coagulation time, clot formation time, TEG reducing rate after 30 minutes maximum amplitude （LY30）, activated partial thrombin time （APTT）, thrombin time （TT） and international normalized ratio （INR）, allP〈0.05; while increased levels angle, maximum amplitude of TEG, coagulationindex, ifbrinogen and D-dimer, allP〈0.05. Compared with Non-resistance group, Resistance group had the higher MACE rate 21.5% vs 7.1%,P〈0.05; in addition, Increased dose subgroup had the lower MACE rate than Maintenance dose subgroup 17.5 vs 25.6%,P〈0.05. Conclusion： Clopidogrel or aspirin resistance had the higher incidence of MACE in elder ACS patients; TEG was helpful for guiding antiplatelet therapy and reducing MACE incidence.

作者田美丽刘焕乐 TIAN Mei-li LIU Huan-le(Health Care Ward, Shengli Oil Field Central Hospital, Dongying 257034, Shangdong, Chin)

机构地区胜利油田中心医院保健病区

出处《中国循环杂志》 CSCD 北大核心 2017年第2期141-144,共4页 Chinese Circulation Journal

关键词血小板聚集抑制剂急性冠状动脉综合征血栓弹力描记术 Platelet aggregation inhibitors Acute coronary syndrome Thromboelastography

分类号 R541 [医药卫生—心血管疾病]

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参考文献3

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