目的：探讨慢性肾病（chronic kidney disease，CKD）与冠心病（coronary atherosclerotic heart disease，CHD）常用阿司匹林与氯吡格雷抗血小板作用的关系，为临床用药提供参考。方法：采用回顾性调查方法，选取经冠脉造影确诊的冠心病患者，根据eGFR分为A组：CHD不伴CKD组；B组：CHD伴CKD组，两组患者在血栓弹力图（thrombelastograph，TEG）检测前均服用阿司匹林0.1 g·d-1和氯吡格雷75 mg·d-1服药时间大于7 d，或者服用阿司匹林0.3 g和氯吡格雷300 mg的负荷量。TEG检测两组花生四烯酸途径抑制率（AA%）、ADP受体抑制率（ADP%），并根据AA%或ADP%判断该病例是否对阿司匹林或氯吡格雷敏感，采用SPSS20.0软件对数据进行统计学处理。结果： A组（n =178）患者对阿司匹林或氯吡格雷敏感性差异无统计学意义（P =0.345），B组（n =144）患者对氯吡格雷的药物敏感性要低于阿司匹林，差异有统计学意义（P =0.012）。结论： CHD患者使用阿司匹林或氯吡格雷抗血小板治疗敏感性无差异，但是在CHD伴有CKD患者中氯吡格雷不敏感比例要多于阿司匹林。%Objective:To determine inhibitory effects of aspirin and clopidogrel on platelets in coronary atherosclerotic heart disease (CHD) patients with chronic kidney disease (CKD), and provide reference for clinical drug use.Methods:By retrospective method, the CHD patients whose diagnoses were conifrmed by coronary angiography were classiifed into two groups according to eGFR (Group A: CHD without CKD group; Group B: CHD with CKD group). All of the patients took aspirin 0.1 g and clopidogrel 75 mg every day at least for 7 days, or aspirin 0.3 g and clopidogrel 300 mg before the PCI operation, and then the inhibitory rates of arachidonic acid (AA%) and ADP receptor pathway (ADP%) on platelets were detected by the thrombelastograph (TEG). The sensitivities of aspirin and clopidogrel were estimated based on results of AA% or ADP%. SPSS20.0 software was used for statistical analysis.Results: The difference between aspirin and clopidogrel on antiplatelet sensitivity in CHD with normal renal function group (A group,n = 178) was not signiifcant (P = 0.345). But in CHD with renal insufifciency group (B group,n = 144), the antiplatelet sensitivity of clopidogrel was inferior to that of aspirin with signiifcant different (P = 0.012).Conclusion:There was no signiifcant difference between aspirin and clopidogrel on antiplatelet effect in CHD with normal kidney function. While, clopidogrel induced less platelet inhibition than aspirin in CHD patients with CKD.
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