在接受西洛他唑辅助治疗的慢性肾脏病患者中与高维持剂量氯吡格雷相比的血小板反应性：根据慢性肾脏病患者氯吡格雷剂量的血小板抑制作用（PIANO-2 CKD）随机研究结果。
Platelet reactivity in patients with chronic kidney disease receiving adjunctive cilostazol compared with a high-maintenance dose of clopidogrel: results of the effect of platelet inhibition according to clopidogrel dose in patients with chronic kidney disease (PIANO-2 CKD) randomized study.
机构信息
Department of Internal Medicine, Division of Cardiology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
出版信息
Am Heart J. 2011 Dec;162(6):1018-25. doi: 10.1016/j.ahj.2011.09.003. Epub 2011 Nov 8.
BACKGROUND
Chronic kidney disease (CKD) is a factor of low response to clopidogrel. We sought to assess the functional impact of cilostazol in CKD patients with undergoing hemodialysis.
METHODS
Seventy-four patients with CKD undergoing hemodialysis and percutaneous coronary intervention were enrolled. Patients were randomly assigned to receive clopidogrel (75 mg/d [group 1, n = 24]), high-maintenance dose of clopidogrel (150 mg/d [group 2, n = 25]), or clopidogrel (75 mg/d) with cilostazol (200 mg/d [group 3, n = 25]) for 14 days. Another 50 patients with normal renal function undergoing percutaneous coronary intervention were treated with 75 mg of clopidogrel and served as the control group. Platelet function was evaluated before and after antiplatelet therapy with light transmittance aggregometry and with VerifyNow P2Y12 assay (Accumetrics, San Diego, CA). Platelet activation markers (soluble CD40 ligand and soluble P-selectin) were also assessed.
RESULTS
The baseline platelet function measurements were similar in the 3 groups of patients; however, the CKD groups had significantly higher platelet aggregation activity compared with the control groups. The rate of high on-treatment platelet reactivity was significantly lower in group 3 than in groups 1 and 2 (10% vs 43% vs 32%, respectively; P < .05). After 14 days of antiplatelet therapy, the changes in plasma soluble CD40 ligand and soluble P-selectin levels were significantly higher in group 3 compared with groups 1 and 2 (P < .01); however, there were no significant differences in platelet function and activation markers between groups 1 and 2.
CONCLUSIONS
Adjunctive cilostazol improves platelet inhibition compared with 75 or 150 mg of clopidogrel in CKD patients undergoing hemodialysis.
背景
慢性肾脏病（CKD）是氯吡格雷低反应的一个因素。我们旨在评估西洛他唑在接受血液透析的 CKD 患者中的功能影响。
方法
共纳入 74 例接受血液透析和经皮冠状动脉介入治疗的 CKD 患者。患者被随机分为氯吡格雷 75mg/d（组 1，n=24）、高维持剂量氯吡格雷 150mg/d（组 2，n=25）或氯吡格雷 75mg/d 加西洛他唑 200mg/d（组 3，n=25）治疗 14 天。另外 50 例肾功能正常的经皮冠状动脉介入治疗患者接受氯吡格雷 75mg 治疗，作为对照组。采用透光比浊法和 VerifyNow P2Y12 测定（Accumetrics，圣地亚哥，CA）评估抗血小板治疗前后的血小板功能。还评估了血小板活化标志物（可溶性 CD40 配体和可溶性 P-选择素）。
结果
3 组患者的基线血小板功能测量值相似；然而，CKD 组的血小板聚集活性明显高于对照组。与组 1 和组 2 相比，组 3 的高治疗血小板反应率明显较低（分别为 10%、43%和 32%；P<.05）。抗血小板治疗 14 天后，组 3 的血浆可溶性 CD40 配体和可溶性 P-选择素水平的变化明显高于组 1 和组 2（P<.01）；然而，组 1 和组 2 之间的血小板功能和活化标志物没有显著差异。
结论
与接受血液透析的 CKD 患者中氯吡格雷 75 或 150mg 相比，辅助西洛他唑可改善血小板抑制作用。
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