【摘要】 目的 本文旨在探讨非糖尿病患者氯吡格雷HTPR相关的影响因素。方法 回顾性分析1 822例氯吡格雷治疗的缺血性心脑血管疾病非糖尿病患者，DNA微阵列试剂盒测定CYP2C19基因型，血栓弹力图测定二磷酸腺苷（ADP）诱导的最大血小板纤维蛋白凝块强度（MAADP）。结果 HTPR患者241例（13.2%）。多因素logistic回归分析表明，性别、年龄、血小板分布宽度（PDW）、CYP2C19基因多态性与HTPR相关。Hosmer-Lemeshow拟合优度检验HTPR预测模型具有良好的校准度（P=0.252）,ROC的曲线下面积为0.704(95%CI:0.670～0.738)。结论 非糖尿病患者氯吡格雷HTPR与性别、年龄、PDW和CYP2C19基因多态性有关，HTPR的预测模型具有良好的区分度和校准度。更多还原

【Abstract】 Objective Patients with clopidogrel high on-treatment platelet reactivity(HTPR)have a higher risk of recurrent vascular events. We attempted to explore risk factors associated with Clopidogrel HTPR in nondiabetics. Methods A total of 1 822 non-diabetics with vascular events received clopidogrel were included. Maximum fibrin clot strength induced by ADP(MAADP)was identified by Thrombelastography,and CYP2C19 genotype was determined by DNA microarray. Results Clopidogrel HTPR was found in 13.2% of the patients(n = 241).Multivariate analysis of logistic regression showed that gender,age,platelet distribution width(PDW),CYP2C19were associated with Clopidogrel HTPR. The Clopidogrel HTPR predictive model had a good calibration by the Hosmer-Lemeshow goodness-of-fit test(P = 0.252),and the area under cure of ROC was 0.704(95%CI:0.670 ～0.738). Conclusions Clopidogrel HTPR in non-diabetics was significantly influenced by gender,age,PDW and CYP2C19 polymorphisms. The predictive model of HTPR has a possibly helpful discrimination and good calibration.更多还原