目的 探讨急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后阿司匹林和氯吡格雷抵抗的发生率及相关影响因素；根据血栓弹力图(TEG)结果指导ACS患者抗血小板药物的使用.方法 用TEG方法检测ACS患者服用阿司匹林和氯吡格雷的血小板抑制率.比较性别、年龄、吸烟、家族史、使用质子泵抑制剂(PPI)、高血压病、高脂血症、糖尿病等对PCI术后阿司匹林和氯吡格雷抵抗的影响,以及对阿司匹林和氯吡格雷抵抗的预测意义.结果 67例ACS患者中13例(19.4％)存在阿司匹林反应低下,9例(13.4％)患者存在氯吡格雷反应低下,3例(4.5％)同时存在阿司匹林反应低下和氯吡格雷反应低下.血小板药物反应低下者44.0％(11/25)合并糖尿病,血小板药物反应正常者11.9％(5/42)合并糖尿病,两者比较差异有统计学意义(P＜0.05)；血小板药物反应正常者女性比例(60.0％)明显高于血小板药物反应低下者(19.1％),两者比较差异有统计学意义(P＜0.05).随着年龄的增长抗血小板药物的反应性会降低(P＜0.05).而两者在吸烟、家族史、使用PPI、合并高血压病、高脂血症比例等方面比较差异无统计学意义(P＞0.05).二分变量线性回归分析结果表明,PCI术后阿司匹林和氯吡格雷抵抗的影响因素包括性别、年龄、糖尿病.结论 对不同性别、年龄的ACS合并糖尿病的患者采用个性化抗血小板治疗,可以减少临床缺血事件的发生.%Objective To identify the incidence and related factors of aspirin and clopidogrel resistance in patients with acute coronary syndrome ( ACS) undergoing percutaneous coronary intervention ( PCI); To guide antiplatelet drugs use according to the results of thrombelastography(TEG) in patients with ACS. Methods Platelet inhibition situation in 67 patients with ACS undergoing PCI were detected by thrombelastography(TEG). Comparing the impact to aspirin and clopidogrel resistance among gender, age, smoking, family history, use of proton pump inhibitor(PPI),hypertension,hyperlipidemia,diabetes. Aspirin and clopidogrel resistance were predicted. Results In 67 ACS patients, there were 13 cases (19. I%) with low response to aspirin, 9 cases (13. 4%) with low clopidogrel response,3 cases(4. 5%) with both low aspirin response and low clopidogrel response. There were 44.0% (11/25) with diabetes in patients with low platelet drug reactions,yet 11. 9% (5/42) with diabetes in the patients with normal platelet drug reactions, there was significant difference between the two groups ( P 0. 05). Dichotomous variable linear regression analysis showed that the related factors of aspirin and clopidogrel resistance in patients with ACS included gender, age, diabetes. Conclusion Individualized antiplatelet therapy for ACS patients with diabetes mellitus of different gender and age can reduce the occurrence of clinical ischemic events.
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