[急性心肌梗死患者抗血小板抵抗与心脏缺血性事件复发的相关性]

[Correlation between antiplatelet resistance and recurrent cardiac ischemic events of patients with acute myocardial infarction].

作者信息

Li Lei, Han Jiang-li, Li Hai-yan, Qiao Rui, Yu Hai-yi, Zeng Hui, Gao Wei, Zhang Jie

机构信息

Department of Cardiology, Peking University Third Hospital.

出版信息

Zhonghua Yi Xue Za Zhi. 2012 Oct 16;92(38):2677-80.

PMID:23290104

Abstract

OBJECTIVE

To evaluate the predictive value of antiplatelet resistance assessed by whole blood electronic impedance aggregometry (EIA) for the risk of recurrent cardiac ischemic events in patients with acute myocardial infarction (AMI) who underwent coronary stenting.

METHODS

We enrolled 109 patients with AMI, 72 (66.1%) men and 37 (33.9%) women with mean age (63 ± 12) years, who were treated with aspirin and clopidogrel daily after coronary stenting. EIA used arachidonic acid (AA) and adenosine diphosphate (ADP) as inductors to measure platelet aggregation inhibited by aspirin and clopidogrel respectively. The subjects were divided into four groups: pure aspirin resistant group (AR, electrical impedance > 0 Ω), pure clopidogrel resistant group (CR, electrical impedance ≥ 10 Ω), dual resistant group (DR) and dual sensitive group (DS). The primary outcomes were recurrent cardiac ischemic events during the 12-month follow-up.

RESULTS

Antiplatelet resistance occurred more often in patients with type 2 diabetes (P = 0.027). The platelet counts (PLT) were higher in antiplatelet resistant groups than DS group (P = 0.013). During the 12-month follow-up, the antiplatelet resistant patients had a higher incidence of recurrent cardiac ischemic events and stent thrombosis (ST) than the patients without (12.5%, 10.0%, 50.0% vs 3.8%, P = 0.036; 6.3%, 10.0%, 50.0% vs 1.3%, P = 0.000; respectively). Binary Logistic regression indicated that dual resistance remained an independent predicator of recurrence cardiac ischemic events and ST (OR 5.99, 95%CI 1.05 - 34.34, P = 0.045; OR 6.36, 95%CI 1.13 - 35.78, P = 0.036; respectively).

CONCLUSIONS

As a physiological assessment of platelet reactivity, EIA is a convenient and accurate option for measuring aspirin resistance. Antiplatelet resistance assessed by EIA is paralleled to clinical events. Dual resistance is an independent predicator for ST and recurrence cardiac ischemic events in patients with AMI.

摘要

目的

评估通过全血电阻抗凝集测定法（EIA）评估的抗血小板抵抗对接受冠状动脉支架置入术的急性心肌梗死（AMI）患者复发性心脏缺血事件风险的预测价值。

方法

我们纳入了109例AMI患者，其中男性72例（66.1%），女性37例（33.9%），平均年龄（63±12）岁，这些患者在冠状动脉支架置入术后每日服用阿司匹林和氯吡格雷。EIA分别使用花生四烯酸（AA）和二磷酸腺苷（ADP）作为诱导剂来测量阿司匹林和氯吡格雷抑制的血小板聚集。受试者被分为四组：单纯阿司匹林抵抗组（AR，电阻抗>0Ω）、单纯氯吡格雷抵抗组（CR，电阻抗≥10Ω）、双重抵抗组（DR）和双重敏感组（DS）。主要结局是12个月随访期间的复发性心脏缺血事件。

结果

2型糖尿病患者中抗血小板抵抗更常见（P = 0.027）。抗血小板抵抗组的血小板计数（PLT）高于DS组（P = 0.013）。在12个月随访期间，抗血小板抵抗患者复发性心脏缺血事件和支架血栓形成（ST）的发生率高于无抗血小板抵抗的患者（分别为12.5%、10.0%、50.0%对3.8%，P = 0.036；6.3%、10.0%、50.0%对1.3%，P = 0.000）。二元Logistic回归表明，双重抵抗仍然是复发性心脏缺血事件和ST的独立预测因素（OR 5.99，95%CI 1.05 - 34.34，P = 0.045；OR 6.36，95%CI 1.13 - 35.78，P = 0.036）。