摘要目的 观察阿司匹林和(或)氯吡格雷治疗对冠心病患者血小板聚集率的影响,初步探讨抗血小板药物抵抗的相关因素.方法 入选确诊为冠心病并已接受阿司匹林和(或)氯吡格雷治疗的患者160例,其中稳定性冠心病(SCHD) 90例,急性冠脉综合征(ACS) 70例,并选择未接受抗血小板药物治疗的非冠心病患者50例作为对照(NCHD).记录研究对象的临床资料,采用连续血小板计数法测定花生四烯酸诱导的最大血小板聚集率(MAR-AA)和二磷酸腺苷诱导的最大血小板聚集率(MAR-ADP),分析冠心病患者抗血小板药物抵抗的发生率及其影响因素.结果 与NCHD组相比,冠心病两组MAR-AA及MAR-ADP较低(P均＜0.05).在ACS患者中,与单用阿司匹林组相比,双抗组MAR-AA与MAR-ADP均明显降低(P均＜0.05).ACS组抗血小板药物抵抗的发生率明显高于SCHD组(20.0％ vs 10.0％,P＜0.05).多因素Logistic回归分析显示,低水平HDL-C(＜1.0mmol/L)是药物抵抗的独立危险因素(OR=4.36,95％ CI:1.36 ～ 14.02,尸=0.014).结论 阿司匹林和(或)氯吡格雷治疗能有效降低冠心病患者的血小板反应性,在ACS患者中双抗血小板治疗抑制血小板聚集的作用更强,ACS患者抗血小板药物抵抗的发生率高于SCHD患者,HDL-C水平降低可能与抗血小板药物抵抗相关.

abstractsObjective To investigate the influence of aspirin and/or clopidogrel treatment on platelet aggregation rate in coronary heart disease (CHD) patients,and discuss the factors related to anti-platelet drug resistance.Methods A total of 160 patients with CHD and received aspirin and/or clopidogrel treatment were enrolled in the Second Xiangya Hospital,Central South University,and were divided into stable coronary heart disease (SCHD) group (n =90) and acute coronary syndrome (ACS) group (n =70).Meanwhile,non-coronary heart disease (NCHD) patients who did not receive anti-platelet drug treatment were enrolled as controls (n =50).Clinical data of the subjects were recorded.The maximum platelet aggregation rate induced by arachidonic acid (MAR-AA) and adenosine diphosphate (MAR-ADP) were evaluated with sequential platelet counting method.The factors related to drug resistance were analyzed with Logistic regression analysis.Results Compared to NCHD group,there were lower MAR-AA and MAR-ADP in two groups of CHD (all P ＜ 0.05).In ACS patients,MAR-AA and MAR-ADP are significantly lower (P ＜0.05) in patients who receive the aspirin and clopidogrel.The rate of anti-platelet drug resistance in ACS group was significantly higher than that in SCHD group (20.0％ vs 10.0％,P ＜ 0.05).Multivariate logistic regression analysis showed that low HDL-C (＜ 1.0 mmol/L) was an independent risk factor related to the anti-platelet drug resistance (OR =4.36,95 ％ CI:1.36-14.02,P =0.025).Conclusions The antiplatelet treatment with aspirin and/or clopidogrel can significantly reduce the platelet reactivity in CHD patients,but some patients still present anti-platelet drug resistance.The combination of aspirin and clopidogrel is better.The rate of drug resistance in ACS patients is high.Low HDL-C might be associated with anti-platelet drug resistance.