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目的探讨行经皮介入治疗(percutaneous coronary intervention PCI)后口服阿司匹林联合氯吡格雷双联抗血小板用药患者,经血栓弹力图(thrombelastography TEG)测得血小板抑制率等提示阿司匹林、氯吡格雷抵抗的发生率,分析其影响因素。方法 2012年08月—2015年08月期间,行PCI患者280例,TEG测得二磷酸腺苷通道血凝块最大强度(MAADP)、花生四烯酸(AA)和二磷酸腺苷(ADP)诱导的血小板抑制率等相关数据,以AA诱导血小板抑制率<50%为阿司匹林抵抗,ADP诱导的血小板抑制率<30%为氯吡格雷抵抗。收集临床及实验资料进行分析。结果全部患者中,阿司匹林抵抗(aspirin resistance)为82例,氯吡格雷抵抗(clopidogrel resistance)88例,发生率为29.3%、31.4%。年龄、吸烟、合并高血压、糖尿病等未影响抗血小板药物抵抗发生。合并用药方面,泮托拉唑未对抗血小板药物抵抗产生影响,使用两种他汀对抗血小板药物反应相似。结论 TEG检测阿司匹林、氯吡格雷抵抗发生率较高,一般临床因素及合并用药对其影响不明确,但应引起临床注意。
Objective To investigate the incidence of aspirin and clopidogrel resistance after oral percutaneous coronary intervention (PCI) with aspirin and clopidogrel in combination with antiplatelet drugs and the inhibition rate of platelets measured by thrombelastography (TEG) , Analyze its influencing factors. Methods Between August 2012 and August 2015, 280 patients with PCI were enrolled in this study. MAADP, arachidonic acid (AA) and adenosine diphosphate (ADP) Induced platelet inhibition rate and other related data to AA-induced platelet inhibition rate of aspirin resistance <50%, ADP induced platelet inhibition rate <30% of clopidogrel resistance. Collect clinical and experimental data for analysis. Results In all patients, aspirin resistance was 82 and clopidogrel resistance was 88 (29.3%, 31.4%). Age, smoking, hypertension, diabetes did not affect the anti-platelet drug resistance. In combination, pantoprazole had no effect on resistance to platelets, and the two statins responded similarly to platelets. Conclusion TEG test aspirin, clopidogrel resistance is higher, the general clinical factors and the impact of the combination of medication is not clear, but should cause clinical attention.