冠心病患者氯吡格雷治疗后残余血小板高反应性的影响因素研究

摘要

Objective To explore the influencing factors for high residual platelet reactivity in patients with coronary heart disease after clopidogrel treatment. Methods We enrolled 513 patients with coronary heart disease who were admitted into Guangdong Province Hospital of Traditional Chinese Medicine from January to December in 2014. According to whether high residual platelet reactivity occurred,the patients were divided into two groups:reactivity group(n=125)and non-reactivity group(n =338). Medical record query method was employed,general data were collected,including admission number, name,gender,age,smoking history,BMI,type of coronary heart disease,complications,situation of medication,situation of left main coronary artery lesion,the number of diseased coronary arteries,HbA1c ,etc. Results Univariate analysis showed that patients with different situations of BMI, type of coronary heart disease, complication with diabetes and the number of diseased coronary arteries≥3 were significantly different in the incidence of high residual platelet reactivity(P﹤0. 05);patients with different gender, age, smoking history and different situations of complications with hypertension, complication with hyperlipidaemia,usage of proton pump inhibitor, usage of statins and left main coronary artery lesion were not significantly different in the incidence of high residual platelet reactivity ( P ﹥0. 05 ) . Multivariate non - conditional logistic regression analysis showed that BMI,kind of coronary disease,complication with diabetes,number of diseased coronary arteries≥3 had significant influence on the incidence of high residual platelet reactivity ( P﹤0. 05 ) . Pearson correlation analysis showed that HbA1c was positively correlated with platelet aggregation rate(r=0. 59,P﹤0. 05). Conclusion BMI,type of coronary heart disease,complication with diabetes and triple vessel disease are the risk factors for high residual platelet reactivity in patients with coronary heart disease,higher HbA1c is associated with higher platelet aggregation rate and higher residual platelet reactivity.%目的：探讨冠心病患者发生氯吡格雷治疗后残余血小板高反应性（残余血小板高反应性）的影响因素。方法选取2014年1—12月到广东省中医院住院治疗的冠心病患者513例。根据是否发生残余血小板高反应性，将患者分为高反应性组（n＝125）和非高反应性组（n＝388）。采用查询病历法，收集患者的一般资料，包括住院号、姓名、性别、年龄、吸烟史、BMI、冠心病类型、合并症、用药情况、左主干病变情况、病变血管数量、血小板聚集率及糖化血红蛋白（ HbA1c ）水平等。结果单因素分析显示，不同BMI、冠心病类型、糖尿病合并情况、血管病变≥3支患者的残余血小板高反应性发生率比较，差异有统计学意义（ P﹤0.05）；不同性别、年龄、吸烟史、高血压合并情况、高脂血症合并情况、质子泵抑制剂使用情况、他汀类药物使用情况、左主干病变情况患者的残余血小板高反应性发生率比较，差异无统计学意义（ P﹥0.05）。多因素非条件Logistic回归分析显示，BMI、冠心病类型、糖尿病合并情况、血管病变≥3支对冠心病患者发生残余血小板高反应性的影响有统计学意义（ P﹤0.05）。Pearson相关分析显示，HbA1c和血小板聚集率呈正相关关系（r＝0.59，P﹤0.05）。结论 BMI、冠心病类型、糖尿病合并情况、血管病变≥3支是冠心病患者发生残余血小板高反应性的影响因素，且HbA1c越高，血小板聚集率越高，残余血小板高反应性越强。