PCI术后血小板聚集功能影响因素的临床分析
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(1. 中国医科大学附属第一医院老年病科,辽宁省沈阳市 110001;2.成都市第二人民医院心内科,四川省成都市 610017;3.无锡明慈心血管病医院心内科,江苏省无锡市 214000;4.中国医科大学附属第一医院心内科,辽宁省沈阳市110001)

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余陆娇,博士研究生,住院医师,主要研究方向为高血压、心力衰竭、冠心病的诊治,E-mail为yljbetty@qq.com。

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辽宁省社会发展攻关计划项目(20122250019)


Clinical analysis of the influence factors of platelet aggregation function after PCI
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1. Department of Gerontology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China;2. Department of Cardiology, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China;3. Department of Cardiology, Wuxi Mingci Cardiovascular Hospital, Wuxi, Jiangsu 214000, China;4. Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China)

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    摘要:

    目的 探讨经皮冠状动脉介入(PCI)术后患者血小板聚集功能的影响因素。 方法 266例冠心病行PCI的患者,均予以氯吡格雷和阿司匹林双联抗血小板及冠心病标准治疗,根据术后血小板聚集率(PAR)分为0%~29%、30%~49%、50%~69%、70%~100%等4组,比较4组患者的CYP2C19基因型、一般临床信息、冠状动脉病变情况及生化指标,并通过Logistic回归分析,找出PAR升高的危险因素。 结果 患者的性别构成比、年龄、脑钠肽(BNP)、CYP2C19基因型在不同PAR分组间存在差异 (P<0.05)。Logistic回归分析显示,PAR升高≥50%的危险因素是女性(OR=2.713, P=0.027)、高BNP(OR=1.002, P=0.007)、CYP2C19呈慢代谢型(OR=5.159, P<0.001);PAR升高≥70%的独立危险因素是女性(OR=5.716, P=0.008)、CYP2C19呈慢代谢型(OR=3.149, P=0.049)。 结论 PAR<50%的患者以CYP2C19快代谢基因型为主,而慢代谢基因型的患者PAR多为50%以上,CYP2C19基因多态性对PAR影响显著。另外,女性、高BNP可能是冠心病患者PCI术后PAR升高的危险因素。

    Abstract:

    Aim To investigate the clinical factors which influence platelet aggregation function in patients after percutaneous coronary intervention(PCI). Methods A retrospective study was conducted on 266 patients with coronary heart disease which underwent PCI. All patients were treated with clopidogrel and aspirin dual anti-platelet therapy and standard medication. Patients were divided into 0%~29%, 30%~49%, 50%~69%, 70%~100% groups according to the adenosine diphosphate(ADP)-induced platelet aggregation rate(PAR). The CYP2C19 genotypes, general clinical information, lab indexes and coronary artery lesions after PCI were compared among the four groups. Risk factors of elevated PAR were explored by logistic regression analysis. Results There were significant differences in gender ratio, age, brain natriuretic peptide(BNP), CYP2C19 genotype among four groups of PAR(P<0.05). Logistic regression analysis revealed that female(OR=2.713, P=0.027), higher BNP(OR=1.002, P=0.007), slow metabolism genotype(OR=5.159, P<0.001) were risk factors for PAR≥50%; and female(OR=5.716, P=0.008), slow metabolism genotype(OR=3.149, P=0.049) was independent risk factor for PAR ≥70%. Conclusion Majority of patients with PAR<50% were fast metabolism genotype, and patients with slow metabolism genotype usually had PAR more than 50%; CYP2C19 polymorphism had strong impact to PAR. In addition, female and higher BNP might be risk factors of elevated PAR in patients with coronary heart disease after PCI.

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余陆娇,谭玲,李贺,张子新. PCI术后血小板聚集功能影响因素的临床分析[J].中国动脉硬化杂志,2017,25(5):490~494, 540.

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  • 收稿日期:2016-04-05
  • 最后修改日期:2017-04-19
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  • 在线发布日期: 2017-05-27