Li Lei, Han Jiang-li, Li Hai-yan, Qiao Rui, Yu Hai-yi, Zhang Jie, Gao Wei
Department of Cardiology, Peking University Third Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2013 Mar 26;93(12):916-20.
To explore the association between clopidogrel resistance (CR) as assessed by whole blood electrical impedance aggregometry (EIA) and platelet parameters.
The prospective study comprised 152 patients with coronary artery disease (CAD) on the therapy of clopidogrel. EIA employed adenosine diphosphate (ADP) as an inductor to measure platelet aggregation. CR was defined by spontaneous aggregation (electrical impedance ≥ 10 Ω). The subjects were divided into 2 groups of CR and clopidogrel sensitive (CS). Platelet parameters were measured by routine blood test. And their clinical data and outcomes were analyzed.
The prevalence of CR was 10.5% (n = 16). The ratio of patients with diabetes in CR group was higher than that in CS group (7/16 vs 29/136, P = 0.046). Platelet counts and mean platelet volume (MPV) were also higher in CR group than those in CS group ((241 ± 58) ×10(9)/L vs (185 ± 56)×10(9)/L, (8.0 ± 0.8) fl vs (7.4 ± 0.9) fl, both P < 0.05). Logistic regression indicated each 10×10(9)/L increase in platelet and each 1 fl increase in MVP were associated with 0.376 and 1.015 folds increase in CR onset respectively (OR = 1.376, 95%CI 1.097 - 1.725, P = 0.006;OR = 2.015, 95%CI 1.148 - 3.537, P = 0.015). The patients with CR had more cardiovascular events during an average follow-up of 53 months (6/16 vs 23/136, P = 0.047).
CAD patients with CR had higher incidence of cardiovascular events. Increased platelet counts and MPV levels are independent predictors for CR in CAD patients.
探讨通过全血电阻抗凝集法（EIA）评估的氯吡格雷抵抗（CR）与血小板参数之间的关联。
这项前瞻性研究纳入了152例接受氯吡格雷治疗的冠心病（CAD）患者。EIA采用二磷酸腺苷（ADP）作为诱导剂来测量血小板聚集。CR定义为自发聚集（电阻抗≥10Ω）。将受试者分为CR组和氯吡格雷敏感（CS）组。通过血常规检测血小板参数。并分析他们的临床资料和结局。
CR的患病率为10.5%（n = 16）。CR组糖尿病患者的比例高于CS组（7/16 vs 29/136，P = 0.046）。CR组的血小板计数和平均血小板体积（MPV）也高于CS组（（241±58）×10⁹/L vs（185±56）×10⁹/L，（8.0±0.8）fl vs（7.4±0.9）fl，均P < 0.05）。Logistic回归表明，血小板每增加10×10⁹/L以及MPV每增加1 fl分别与CR发生风险增加0.376倍和1.015倍相关（OR = 1.376，95%CI 1.097 - 1.725，P = 0.006；OR = 2.015，95%CI 1.148 - 3.537，P = 0.015）。在平均53个月的随访期间，CR患者发生更多心血管事件（6/16 vs 23/136，P = 0.047）。
CR的CAD患者心血管事件发生率更高。血小板计数和MPV水平升高是CAD患者CR的独立预测因素。
