Costache Irina Iuliana, Rusu Cristina, Ivanov I, Popescu Roxana, Petriş A
University of Medicine and Pharmacy Grigore T Popa Iasi, Faculty of Medicine.
Rev Med Chir Soc Med Nat Iasi. 2012 Oct-Dec;116(4):962-7.
the purpose of the present study was to determine the relationship between the Clopidogrel genetic response (based on laboratory specific tests) and the worse evolution of the patients with acute coronary syndromes.
The study included 80 patients (11 females and 69 males), aged between 45 - 85 years, admitted in the 1st Department of Cardiology, between January June 2012, diagnosed with acute coronary syndromes (especially unstable angina). All the patients received Clopidogrel as antiplatelet agent, in some cases associated with aspirin. The diagnosis of acute coronary syndrome was based on clinical, ECG, echocardiographic and enzymatic signs. All the patients accepted to be included in the present study and signed a consent formulary. The Clopidogrel resistance was determined by specific genetic laboratory tests.
Of 80 cases, 4 patients were identified as normal responders (5%), 3 patients were low responders (3.75%), 58 patients were high responders (72.5%) and 15 patients were unpredictable (18.75%). In the high responders' group a lot of hemorrhagic disorders in different territories were identified. Normal responders had a good evolution. In patients with low response and unpredictable status the recurrence of angina and left ventricular failure as complications were frequent.
The present study allowed a positive correlation between the haemorrhagic events and the high responder status to Clopidogrel. Low responder patients or those with an unpredictable phenotype had a worse evolution caused by the recurrence of angina or left ventricular failure.
本研究的目的是确定氯吡格雷基因反应（基于实验室特定检测）与急性冠脉综合征患者病情恶化之间的关系。
本研究纳入了80例患者（11例女性和69例男性），年龄在45至85岁之间，于2012年1月至6月期间入住第一心脏病科，诊断为急性冠脉综合征（尤其是不稳定型心绞痛）。所有患者均接受氯吡格雷作为抗血小板药物治疗，部分患者还联合使用了阿司匹林。急性冠脉综合征的诊断基于临床、心电图、超声心动图和酶学指标。所有患者均同意纳入本研究并签署了知情同意书。通过特定的基因实验室检测来确定氯吡格雷抵抗情况。
在80例病例中，4例被确定为正常反应者（5%），3例为低反应者（3.75%），58例为高反应者（72.5%），15例为不可预测者（18.75%）。在高反应者组中，发现不同部位有许多出血性疾病。正常反应者病情进展良好。低反应者和不可预测状态的患者中，心绞痛复发和左心室衰竭作为并发症很常见。
本研究证实出血事件与氯吡格雷高反应状态之间存在正相关。低反应患者或表型不可预测的患者因心绞痛复发或左心室衰竭导致病情恶化。
