老年冠心病患者氯吡格雷抵抗的影响因素研究

摘要

Objective Investigate the prevalence and influential factors of clopidogrel resistance on eld-erly patients with coronary heart disease. Methods A lolal of 146 patients with coronary heart disease trea-ted with aspirin and clopidogrel after PCI were enrolled, and were examined with fasting thrombelastography 3 d after PCT. Patients were divided into clopidogrel resistance group and clopidogrel sensitive group accord-ing to adenosine diphosphate-induced platelet aggregation inhibition rate. The imaging characteristics bio-chemical parameters and general clinical data,were compared between two groups,and the independent risk factors of clopidogrel resistance were explored by Logistic regression analysis. Results Logistic regression a-nalysis revealed that female(OR=3.462,95%CI 1.415~7.962),history of smoking(OR=4.941,95%CI 1.245~21. 762),history of diabetes(OR =3. 253,95%CI 1. 374~7. 592),fasting blood-glucose≥11. 1mmol/L(OR=2. 176,95%CI 1. 073~4. 632),glycosylated hemoglobin≥7%(OR=3. 715,95%CI 1. 826~7.472), troponin≥0.13 mkg/LOR=5.642,95%CI 2.934~9.758)and triacylglycerol≥2.26 mmol/LOR=2. 694,95%CI 1. 634~4. 938)were independent risk factors of clopidogrel resistance. Conclusion Female gender,diabetes,smoking,high blood lipids and myocardial enzyme elevation might be risk factors of clopidogrel resistance in patients with coronary heart disease after PCI.%目的：研究老年冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入术( PCI)后氯吡格雷抵抗的影响因素。方法将2009年1月至2012年12月间福建医科大学附属龙岩第一医院收治的146例老年冠心病患者根据血栓弹力图检测结果分为抵抗组和敏感组,均使用氯吡格雷抗血小板治疗,比较两组患者各因素对氯吡格雷抵抗的影响。结果 Logistic回归分析结果显示氯吡格雷抵抗的独立危险因素有女性(OR=3.462,95%CI 1.415~7.962),吸烟史(OR=4.941,95%CI 1.245~21.762),糖尿病史(OR=3.253,95%CI1.374~7.592),空腹血糖≥11.1 mmol/L(OR=2.176,95%CI1.073~4.632),糖化血红蛋白≥7%(OR=3.715,95%CI1.826~7.472),肌钙蛋白≥0.13 mkg/L(OR=5.642,95%CI2.934~9.758),三酰甘油≥2.26 mmol/L(OR=2.694,95%CI1.634~4.938)。结论性别因素、行为因素、以及生化因素是造成氯吡格雷抵抗的主要原因,需要采取差异化抗凝治疗。