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目的:评价不同维持剂量氯吡格雷对直接冠状动脉介入(PPCI)术后发生氯吡格雷抵抗患者的疗效和安全性。方法:回顾性分析2008-01-2011-01因急性心肌梗死(AMI)于我院抢救中心住院行PPCI,术后5d化验检查发现氯吡格雷抵抗的患者277例。所有患者均于术前常规给予口服氯吡格雷负荷剂量300mg、阿司匹林300mg;术后常规给予阿司匹林100mg/d,术后1～4d服用氯吡格雷75mg/d。根据术后第5天起服用氯吡格雷剂量分为75mg/d组(156例)和150mg/d组(121例)。观察2组二磷酸腺苷(ADP)及临床事件发生情况。结果:术后第5天2组ADP值差异无统计学意义(P=0.201);而150mg/d组术后14d(P=0.039)、30d(P=0.038)、90d(P=0.010)和180d(P=0.012)ADP值均显著低于75mg/d组,均差异有统计学意义。术后30d时2组AMI发生率(P=0.634)、病死率(P=0.391)和轻度出血发生率P=0.476)均差异无统计学意义。而在随访180d时150mg/d组AMI发生率(P=0.041)和病死率(P=0.034)均显著低于75mg/d组,均差异有统计学意义;而2组轻度出血发生率(P=0.371)差异无统计学意义。随访过程中2组均无中、重度出血发生。Logis-tic回归分析结果显示,应用氯吡格雷150mg/d是180d时发生AMI(OR=1.236,95%CI:0.567～2.071,P=0.023)的独立影响因素,但不是180d时病死率(OR=0.522,95%CI:0.218～1.369,P=0.224)的独立影响因素。结论:对PPCI术后发生氯吡格雷抵抗的患者,增加氯吡格雷维持量能进一步抑制血小板功能,进而减少临床不良事件的发生率,而且安全性良好。
AIM: To evaluate the efficacy and safety of clopidogrel at different maintenance doses of clopidogrel in patients undergoing direct coronary intervention (PPCI). Methods: A retrospective analysis was performed on PPCI in our hospital from January 2008 to November 2011 due to acute myocardial infarction (AMI). A total of 277 patients were found to have clopidogrel resistance after 5 days of operation. All patients were given preoperative oral clopidogrel dose 300mg, aspirin 300mg; postoperative routine aspirin 100mg / d, 1 ~ 4d after taking clopidogrel 75mg / d. According to the clopidogrel dose on the 5th postoperative day, it was divided into 75 mg / d group (156 cases) and 150 mg / d group (121 cases). Two groups of adenosine diphosphate (ADP) and clinical events were observed. Results: There was no significant difference in ADP between the two groups on the fifth day after operation (P = 0.201) 180d (P = 0.012) ADP values were significantly lower than 75mg / d group, the difference was statistically significant. There was no significant difference in AMI incidence (P = 0.634), case fatality (P = 0.391) and mild bleeding incidence (P = 0.476) at 30 days after operation. However, the incidence of AMI in 150mg / d group was significantly lower than that in 75mg / d group (P = 0.041) and mortality at 180d after follow-up (P = 0.034) P = 0.371) the difference was not statistically significant. During follow-up, there was no moderate or severe bleeding in both groups. Logistic regression analysis showed that clopidogrel 150mg / d was an independent influencing factor of AMI (OR = 1.236,95% CI 0.567 ~ 2.071, P = 0.023) at 180 days, but not at 180 days = 0.522, 95% CI: 0.218-1.369, P = 0.224). CONCLUSIONS: Clopidogrel maintenance in patients with clopidogrel resistance after PPCI can further inhibit platelet function, thereby reducing the incidence of clinical adverse events and with good safety.