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目的探讨急性冠状动脉综合征(ACS)患者中氯吡格雷抵抗(CPGR)的发生率及影响因素。方法入选100例拟行经皮冠状动脉介入治疗(PCI)的ACS患者,服用负荷量氯吡格雷(CPG)前、服药后24 h分别采血,利用光比浊法测定血浆二磷酸腺苷(ADP)诱导的血小板聚集率(PA),根据PA抑制程度判断CPGR发生率,并据此分为CPGR组和非CPGR组。对ACS患者临床危险因素与CPGR进行相关分析。结果 100例ACS患者中有23例发生CPGR,CPGR发生率为23%。CPGR组和非CPGR组在基线临床特征和合并用药方面差异均无统计学意义(P>0.05)。但CPGR组基线PA明显低于非CPGR组(P<0.05),基线PA是CPGR的独立预测指标。结论 ACS和PCI术后抗血小板治疗中,部分患者确实存在CPGR现象。基线PA水平对CPGR具有重要的预测价值。
Objective To investigate the incidence and influencing factors of clopidogrel resistance (CPGR) in patients with acute coronary syndrome (ACS). Methods One hundred ACS patients undergoing percutaneous coronary intervention (PCI) were enrolled in this study. Before taking clopidogrel (CPG), blood samples were taken 24 h after taking the drug. The levels of plasma ADP, Induced platelet aggregation rate (PA), according to the degree of PA inhibition to determine the incidence of CPGR, and accordingly divided into CPGR group and non-CPGR group. The correlation between clinical risk factors and CPGR in ACS patients was analyzed. Results Twenty-three of 100 patients with ACS developed CPGR with a 23% incidence of CPGR. There was no significant difference in baseline clinical characteristics and combination therapy between CPGR group and non-CPGR group (P> 0.05). However, baseline PA in CPGR group was significantly lower than that in non-CPGR group (P <0.05). Baseline PA was an independent predictor of CPGR. Conclusion In antiplatelet therapy after ACS and PCI, some patients do have CPGR phenomenon. Baseline PA levels have important predictive value for CPGR.