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目的探讨双联抗血小板疗法与单独应用阿司匹林对外周动脉疾病血管内治疗的病人局部血小板活化与临床终点的影响。方法病人于介入前服用500mg或300mg氯吡格雷,介入后每日服用阿司匹林100mg和氯吡格雷75mg或相同剂量的阿司匹林与安慰剂(氯吡格雷替代品),为期6个月。主要终点是血小板活化标记物β-血小板球蛋白和CD40L的局部浓度,以及病人对氯吡格雷的抗药率。次要终点包括介入后6个月的临床进展。结果入组病人80例,两组各40例。氯吡格雷组和安慰剂组β-血小板球蛋白平均介入周围浓度分别为224.5与365.5(P=0.03),CD40L的浓度分别为127和206.5(P=0.05)。30%接受氯吡格雷的病人具有抗药性。2例氯吡格雷组和8例安慰剂组病人需目标病灶血运重建(P=0.04)。需血运重建的氯吡格雷组病人对氯吡格雷均具抗药性。1例氯吡格雷组和2例安慰剂组病人并发轻微出血。结论双联抗血小板疗法可减少介入周围血小板活化,并可改善其功能而未并发大量出血。个体化双联抗血小板疗法对于外周动脉疾病病人的血管内治疗效果较满意。要点①探讨血管内治疗后氯吡格雷和阿司匹林的作用。②相比单纯应用阿司匹林,双联抗血小板疗法可减少介入周围血小板活化。③双联抗血小板疗法可改善血管内治疗病人的疗效。④当治疗血管内外周动脉疾病时,氯吡格雷抗药性很重要。
Objective To investigate the effects of dual antiplatelet therapy and aspirin alone on local platelet activation and clinical end points in patients undergoing endovascular treatment of peripheral arterial disease. Methods Patients received either 500 mg or 300 mg of clopidogrel prior to intervention and received aspirin 100 mg and clopidogrel 75 mg daily or aspirin and placebo (clopidogrel replacement) at the same dose for 6 months after intervention. The primary endpoint was the local concentration of platelet-activating markers β-thromboglobulin and CD40L, as well as the patient’s resistance to clopidogrel. Secondary endpoints included the clinical progression of 6 months after intervention. Results 80 patients into the group, two groups of 40 cases. The average concentrations of β-thromboglobulin in the clopidogrel and placebo groups were 224.5 and 365.5, respectively (P = 0.03). The concentrations of CD40L were 127 and 206.5, respectively (P = 0.05). 30% of patients receiving clopidogrel are resistant. Two patients with clopidogrel and eight placebo required revascularization of the target lesion (P = 0.04). Clopidogrel patients requiring revascularization were resistant to clopidogrel. One patient with clopidogrel and two patients receiving placebo experienced mild bleeding. Conclusions Dual antiplatelet therapy can reduce the activation of peripheral platelets and improve their function without massive haemorrhage. Individualized dual antiplatelet therapy is more satisfactory for endovascular treatment of patients with peripheral arterial disease. Key points ① Explore the role of clopidogrel and aspirin after endovascular treatment. ② compared to simple application of aspirin, dual antiplatelet therapy can reduce the involvement of peripheral platelet activation. ③ dual antiplatelet therapy can improve the efficacy of endovascular treatment of patients. ④ When treating intravascular arterial disease, clopidogrel resistance is very important.