经皮冠状动脉介入治疗患者抗血小板药物抵抗的相关因素分析

摘要

Objective To evaluate the prevalence and clinical risk factors of antiplatelet drug resistance in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods Antiplatelet drug resistance was assessed by thrombelastograph (TEG) in 381 ACS patients undergoing PCI who received combined treatment of aspirin and clopidogrel.Clopidogrel reisistance (CR) was defined as ADP-induced platelet aggregation inhibition (ADP-PAI) rate 0.05).However,AA-PAI in elderly women was significantly lower than that of young women (P0.05);而老年女性的AA-PAI显著低于非老年女性(P<0.01).老年女性较同龄男性ADP-PAI更低(P<0.05);而年轻女性AA-PAI较同龄男性明显升高(P<0.01).结论 PCI术后的ACS患者,FBG及HDL升高是CR的高危因素;糖尿病病程长及高hs-CRP水平的患者更容易发生AR.糖尿病病程长、血糖控制不佳患者更易发生2种抗血小板药物联合抵抗,这种患者相当危险.老年女性CR风险高于同龄男性,而年轻男性及老年女性发生AR的风险偏高.了解抗血小板治疗抵抗高危因素,对于高危患者,早期筛查、早期诊断、及时改变治疗方案可能是预防PCI术后血栓形成并发症的有效方法之一.