吸烟状态对氯吡格雷疗效的影响

摘要

Objective To investigate whether smoking status has a differential clinical impact on the efficacy of clopidogrel among recent ischemic stroke patients.Methods We recruited 202 non-cardioembolic ischemic stroke patients treated with clopidogrel from January 2013 to October 2014.Patients were categorized as active smokers and non-active-smokers.The platelet inhibitive rate with clopidogrel therapy for at least 5 days was measured using thrombelastography.Results The platelet inhibitive rate showed a higher trend in smokers vs non-smokers (55.29%±25.92% vs 53.25%±27.02%,P=0.589).And a relatively lower occurrence rate of hyporeactivity of clopidogrel was observed in the smokers compared with non-smokers.Conclusions Compared with nonsmokers,clopidogrel therapy in current smokers with non-cardioembolic ischemic stroke may strengthen platelet inhibition and decrease aggregation,leading to more potent efficacy,which needs further evaluation in additional studies of larger size.%目的 通过血栓弹力图检测,观察吸烟状态是否会对缺血性卒中患者的氯吡格雷疗效产生影响.方法 回顾性连续纳入2013年1月-2014年10月首次发病的急性非心源性栓塞所致的缺血性脑血管病并接受氯吡格雷治疗的患者202例,分为吸烟组和不吸烟组.连续服用氯吡格雷每日75 mg,5 d后,抽取外周静脉血,用血栓弹力图仪测定氯吡格雷对血小板的抑制率.结果 与非吸烟组相比,吸烟组患者氯吡格雷诱导的二磷酸腺苷抑制率更高(55.29%±25.92% vs 53.25%±27.02%,P=0.589),出现氯吡格雷反应低下(二磷酸腺苷抑制率<30%)的患者比例更低(15.8% vs 19.5%,P=0.498),但差异无统计学意义.结论 在非心源性栓塞的缺血性卒中患者中,吸烟有提高氯吡格雷反应性,增强其抗血小板聚集作用的趋势.但吸烟者中氯吡格雷治疗后血小板反应的变异性仍有待进一步研究证实.