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目的:探讨血小板聚集率(platelet aggregation rate,PAR)已达标的冠心病患者行冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后氯吡格雷抵抗的发生率和影响因素。方法:入选患者177例,年龄29～78岁,口服双联抗血小板药物PAR均已达标,行PCI术后部分患者PAR升高并>50%,术后氯吡格雷抵抗组27例和氯吡格雷有反应组150例。结果:术后氯吡格雷抵抗的发生率15.3%。氯吡格雷抵抗组和有反应组PAR分别为(58.5±6.3)%和(33.5±9.5)%(P<0.001)。多因素Logistic回归提示高血压病史(P=0.032,OR=3.309,95%CI1.106～9.899),术前PAR(P<0.001,OR=1.165,95%CI1.079～1.258,术前使用奥美拉唑(P=0.008,OR=5.414,95%CI1.540～19.028)和造影剂用量(P=0.009,OR=1.009,95%CI1.002～1.016)是术后氯吡格雷抵抗的影响因素。结论:术前PAR达标的冠心病患者PCI术后氯吡格雷抵抗的发生率15.3%。高血压病史、术前PAR偏高、术前使用奥美拉唑和造影剂用量是氯吡格雷抵抗的影响因素。
Objective: To investigate the incidence and influencing factors of clopidogrel resistance after coronary intervention (percutaneous coronary intervention) in patients with coronary heart disease who have achieved platelet aggregation rate (PAR). Methods: A total of 177 patients were enrolled in this study. The age ranged from 29 to 78 years old. The oral dual antiplatelet drug PAR was achieved. PAR was increased by more than 50% in some patients after PCI. In the postoperative clopidogrel resistance group, Gray has a reaction group of 150 cases. Results: The incidence of postoperative clopidogrel resistance was 15.3%. The clopidogrel resistance group and responsive group PAR were 58.5 ± 6.3% and 33.5 ± 9.5%, respectively (P <0.001). Multivariate logistic regression showed that the preoperative hypertension (P = 0.032, OR = 3.309, 95% CI 1.106-9.899), preoperative PAR (P <0.001, OR = 1.165, 95% CI 1.079-1.258, (P = 0.008, OR = 5.414, 95% CI 1.540 ~ 19.028) and the amount of contrast medium (P = 0.009, OR = 1.009, 95% CI 1.002 ~ 1.016) were the impact of postoperative clopidogrel resistance Factors.Conclusion: The incidence of clopidogrel resistance after PCI in patients with preoperative PAR of coronary heart disease was 15.3% .Hypertension history, preoperative PAR was high, preoperative use of omeprazole and contrast agent were clopidogrel Factors influencing resistance.