吸烟对氯吡格雷抗血小板疗效及安全性的影响

摘要

目的 通过检测吸烟组和非吸烟组患者应用氯吡格雷后的血小板抑制率,探讨吸烟对氯吡格雷抗血小板聚集的影响.方法 回顾性分析2016年1月至10月在火箭军总医院心内科接受经皮冠状动脉介入(PCI)治疗且应用血栓弹力图(TEG)监测抗血小板疗效的患者151例.依据是否吸烟分为两组:吸烟组(n=72)和非吸烟组(n=79).随访住院期间及术后6个月内的主要不良心血管事件(MACE)及出血事件.结果 PCI术后3 d及术后1个月,吸烟组患者的ADP抑制率均显著高于非吸烟组,差异具有统计学意义(80.94±22.57 vs 66.65±26.25, 81.64±20.37 vs 69.15±22.89;P<0.05).随访6个月,吸烟组患者发生MACE 7例,轻微出血事件3例;非吸烟组患者发生MACE 9例,轻微出血事件4例;两组患者均无严重出血事件发生;两组患者的MACE及出血事件发生情况差异无统计学意义(P>0.05).结论 吸烟可增强氯吡格雷抗血小板聚集的疗效.%Objective To investigate the impact of smoking on the antiplatelet effect of clopidogrel by observing the rate of platelet inhibition between the smoking and non-smoking patients after the administration.Methods A total of 151 patients undergoing percutaneous coronary intervention (PCI) followed by monitoring of thrombelastography (TEG) in the General Hospital of PLA Rockets Force were enrolled in this study.They were divided into smoking group (n=72) and non-smoking group (n=79).The incidences of bleeding and major adverse cardiovascular events (MACE) were recorded in hospital stay and in 6 months after operation, and compared between the 2 groups.Results TEG demonstrated that the platelet inhibition rate (adinosine diphosphate pathway) was significantly higher in smoking group than in non-smoking group in 3 day and 1 month after PCI (80.94±22.57 vs 66.65±26.25, 81.64±20.37 vs 69.15±22.89;P<0.05).In 6 months after operation, MACE was reported in 7 cases and minor bleeding in 3 cases in smoking group;MACE was reported in 9 cases and minor bleeding in 4 cases in non-smoking group;no severe bleeding was reported in either group;There were no obvious differences in the incidences of MACE and bleeding between the 2 groups (P>0.05).Conclusion Exposure to smoking may enhance the antiplatelet effect of clopidogrel.