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目的:探讨冠心病患者行冠状动脉介入治疗术后氯吡格雷抵抗的发生率和影响因素。方法:冠心病患者317例,均经标准双联抗血小板药物治疗后行经皮冠状动脉介入治疗。以6μmol/L二磷酸腺苷作为诱导剂,根据比浊法测定术后第1天血小板聚集率的结果将317例患者分为氯吡格雷抵抗组和氯吡格雷有反应组,分析2组临床指标的差异。结果:氯吡格雷抵抗发生率24.0%。氯吡格雷抵抗组和氯吡格雷有反应组血小板聚集率分别为(58.4±7.0)%和(34.3±9.5)%(P<0.001)。多因素Logistic回归分析结果提示陈旧性心肌梗死病史(P=0.032,优势比2.834,95%CI1.091～7.361)、合并2型糖尿病(P=0.016,优势比2.130,95%CI1.151～3.941)和血清尿酸水平(P=0.004,优势比1.005,95%CI1.002～1.009)与氯吡格雷抵抗呈正相关。结论:陈旧心肌梗死病史、合并2型糖尿病和血清尿酸水平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 in patients with coronary heart disease. Methods: 317 patients with coronary heart disease were treated with standard dual antiplatelet drugs and percutaneous coronary intervention. 317 patients were divided into clopidogrel resistance group and clopidogrel reaction group according to the results of turbidimetric method to determine the platelet aggregation rate on the first day after using 6μmol / L adenosine diphosphate as inducer. Two groups of clinical Differences in indicators. Results: The incidence of clopidogrel resistance was 24.0%. Platelet aggregation rates were (58.4 ± 7.0)% and (34.3 ± 9.5)%, respectively (P <0.001) in the clopidogrel-resistant and clopidogrel-responsive groups. Multivariate logistic regression analysis showed that the history of old myocardial infarction (P = 0.032, odds ratio 2.834, 95% CI1.091 ~ 7.361), type 2 diabetes mellitus (P = 0.016, odds ratio 2.130, 95% CI1.151 ~ 3.941 ) And serum uric acid level (P = 0.004, odds ratio 1.005, 95% CI 1.002 ~ 1.009) were positively correlated with clopidogrel resistance. Conclusion: The history of old myocardial infarction, combined with type 2 diabetes mellitus and serum uric acid levels are the influencing factors of clopidogrel resistance.