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目的:观察肾功能不全患者经皮冠状动脉介入(PCI)术后阿司匹林与氯吡格雷双联抗血小板治疗,对血小板CD41+CD62P+表达的影响及意义。方法:选择132例经冠状动脉造影检查确诊并行PCI术者,其中肾功能不全15例,肾功能正常者117例,两组患者均以300mg氯吡格雷负荷,继而75mg/d治疗及阿司匹林100mg/d,于治疗前及术后1个月采静脉血,应用流式细胞术检测治疗前后血小板CD41+CD62P+阳性率。随访3个月,观察两组患者心血管不良事件发生率。结果:术前肾功能正常组与肾功能不全组血小板CD41+CD62P+阳性率分别为(17.54±13.30)%和(19.78±10.74)%(P>0.05),治疗1个月后两组患者血小板CD41+CD62P+表达阳性率分别为(5.72±6.59)%和(10.61±9.90)%,均较治疗前显著降低(均P<0.05),肾功能正常组下降幅度高于肾功能不全组(P<0.05)。在3个月的随访中,两组患者各发生心血管不良事件1例(0.85%∶6.67%,P>0.05)。结论:肾功能不全患者PCI术后双联抗血小板疗效低于肾功能正常的PCI患者。
Objective: To observe the effect of aspirin plus clopidogrel dual antiplatelet therapy on platelet CD41 + CD62P + expression after percutaneous coronary intervention (PCI) in patients with renal insufficiency. Methods: A total of 132 patients undergoing PCI underwent coronary angiography were enrolled. Among them, 15 cases had renal insufficiency and 117 cases had normal renal function. Both groups received 300 mg clopidogrel loading, 75 mg / d aspirin and 100 mg / d, venous blood was collected before treatment and 1 month after operation, and the positive rate of CD41 + CD62P + before and after treatment was detected by flow cytometry. The patients were followed up for 3 months to observe the incidence of cardiovascular adverse events in both groups. Results: The positive rate of platelet CD41 + CD62P + in normal renal function group and renal insufficiency group before surgery was (17.54 ± 13.30)% and (19.78 ± 10.74)%, respectively (P> 0.05). After 1 month of treatment, the platelet CD41 (5.72 ± 6.59)% and (10.61 ± 9.90)%, respectively, both of which were significantly lower than those before treatment (all P <0.05), and those in the normal renal function group were significantly lower than those in the renal dysfunction group (P <0.05) ). In the 3-month follow-up, one case of cardiovascular adverse events occurred in both groups (0.85% vs.6.67%, P> 0.05). Conclusions: The efficacy of dual antiplatelet therapy in patients with renal insufficiency after PCI is lower than that in patients with normal renal function.