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目的探讨以西洛他唑为基础的三联抗血小板治疗对氯吡格雷低反应性(CLR)患者的临床疗效。方法将经皮冠状动脉介入治疗(PCI)术后经光学血小板聚集仪测定的CLR患者90例随机均分为双联抗血小板治疗组(DAPT组)和三联抗血小板治疗组(TAPT组)。观察两组血小板聚集功能及心血管事件发生情况。结果与DAPT组相比,TAPT组术后治疗1个月时二磷酸腺苷诱导的血小板聚集率(PL_(ADP))降低[(34.47±12.63)%vs.(43.67±10.32)%](P<0.01),而花生四烯酸诱导的血小板聚集率(PL_(AA))无统计学差异[(3.46±2.82)%vs.(3.87±2.87)%](P>0.05)。术后1年随访,DAPT组心源性再入院患者多于TAPT组,轻微出血患者少于TAPT组(P<0.05)。结论与常规双联抗血小板治疗相比,以西洛他唑为基础的三联抗血小板治疗能有效改善CLR,减少心血管不良事件发生率,不增加严重出血风险。
Objective To investigate the clinical efficacy of cilostazol-based triple antiplatelet therapy in patients with clopidogrel hyporesponsiveness (CLR). Methods Ninety patients with CLR who were measured by optical platelet aggregation after percutaneous coronary intervention (PCI) were randomly divided into dual antiplatelet therapy group (DAPT group) and triple antiplatelet therapy group (TAPT group). The platelet aggregation and cardiovascular events were observed in two groups. Results Compared with DAPT group, ADP-induced platelet aggregation (PLP) decreased (P <0.05) in the TAPT group after one month of treatment [(34.47 ± 12.63) vs (43.67 ± 10.32)%] (P <0.05). There was no significant difference in the platelet aggregation rate (PL_ (AA)) induced by arachidonic acid (3.46 ± 2.82% vs 3.87 ± 2.87%) (P> 0.05). At 1-year follow-up, cardiac rehospitalization was more frequent in the DAPT group than in the TAPT group, with minor bleeding less than in the TAPT group (P <0.05). Conclusion Compared with conventional dual antiplatelet therapy, cilostazol-based triple antiplatelet therapy can effectively improve CLR, reduce the incidence of cardiovascular adverse events, without increasing the risk of severe bleeding.