【摘要】 【目的】探讨急性冠脉综合征(ACS)行经皮冠状动脉介入治疗术(PCI)后患者口服多种P2Y12受体拮抗剂发生抵抗的影响因素。【方法】入选174例ACS行PCI术患者,男女比例为3.5∶1;平均年龄(67.8±11.8)岁(40~91岁)。氯吡格雷治疗占113例(64.9%),普拉格雷治疗占20例(11.5%),替格瑞洛治疗占41例(23.6%)。于PCI术后连续服用阿司匹林和一种P2Y12受体拮抗剂至少5 d或以上(中位数为11 d,范围5~180 d),之后采用Verify Now系统进行血小板功能监测,根据血小板反应性结果分为非抵抗组(PRU<208)和抵抗组(PRU≥208)。【结果】P2Y12受体拮抗剂抵抗者57例(32.8%),其中氯吡格雷抵抗占55例(48.7%),普拉格雷抵抗占2例(10.0%),两者比较差异有统计学意义(P<0.001);替格瑞洛组未检出抵抗。Logistic回归分析显示糖尿病和肾功能不全是PCI术后发生氯吡格雷抵抗的独立危险因素(P<0.05)。【结论】P2Y12受体拮抗剂抵抗以氯吡格雷抵抗为主,糖尿病和肾功能不全是氯吡格雷抵抗的独立危险因素。新型口服P2Y12受体拮抗剂为氯吡格雷抵抗和PCI术后患者提供了新选择。更多还原

【Abstract】 【Objective】 To investigate the affecting factors for resistance occurring after orally taken multiple P2Y12 receptor antagonists in patients with acute coronary syndrome(ACS) undergone percutaneous coronary intervention(PCI). 【Methods】 A total of 174 patients with ACS who had undergone PCI were enrolled in this study. The proportion between male and female was 3.5 to 1.The average age was 67.8 ± 11.8 years old(40 ~ 91 years old). There were 113 cases(64.9%) of clopidogrel, 20 cases(11.5%) of prasugrel and 41 cases(23.6%) of ticagrelor. Qualified cases orally intake aspirin and one kind of P2Y12 receptor antagonists for at least consecutive five days or above(median: 11 days, rang: 5 ~ 180 days) after PCI. Afterwards, using Verify Now to monitor the platelet function of these patients and divide them into the non-resistant group(PRU < 208) and the resistant group(PRU ≥ 208)according to the result of the platelet reactivity. 【Results】 There were 57 cases(32.8%) of P2Y12 resistance, in which 55 cases(48.7%) were clopidogrel resistance, while prasugrel resistance were only 2 cases(10.0%), significant difference was found between them(P < 0.001). However, resistance was not identified in the group of ticagrelor. Logistic regression analysis showed that diabetes mellitus and renal insufficiency were independent risk factors for clopidogrel resistance after PCI(P < 0.05). 【Conclusion】 P2Y12 receptor antagonist resistance was mostly clopidogrel resistance. Diabetes mellitus and renal insufficiency were independent risk factors for clopidogrel resistance. Novel oral P2Y12 receptor antagonists provided a new choice for patients with clopidogrel resistance andfollowing stent implantation.更多还原