《中国康复理论与实践》

《中国康复理论与实践》 ›› 2010, Vol. 16 ›› Issue (11): 1057-1059.

• 论文 • 上一篇    下一篇

吸烟对冠心病心绞痛型患者经皮冠状动脉介入治疗术后二联抗血小板疗效的影响

叶明1a，乔岩1b，刘畅1b，严研1a，李南1a   

  1. 1.首都医科大学附属北京安贞医院,a.抢救中心;b.心内科，北京市 100029
  • 收稿日期:2010-07-19 修回日期:1900-01-01 出版日期:2010-11-25 发布日期:2010-11-25
  • 通讯作者: 李南

Smoking Associated with Aspirin and Clopidogrel Resistance in Patients with Stable Angina after Percutaneous Coronary Intervention

YE Ming, QIAO Yan, LIU Chang, et al   

  1. Emergency Center for Heart, Lung and Vessel Diseases, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China
  • Received:2010-07-19 Revised:1900-01-01 Published:2010-11-25 Online:2010-11-25

PDF (PC)

摘要： 目的观察吸烟对冠心病心绞痛型患者经皮冠状动脉介入治疗（PCI）术后二联抗血小板疗效的影响。方法冠心病心绞痛PCI术后患者493例，均连续服用阿司匹林100 mg/d达7 d以上，根据病史分为吸烟组241例和非吸烟组252例，入选时所有患者均测定花生四烯酸(AA)和二磷酸腺苷(ADP)诱导的血小板聚集率，后予氯吡格雷300 mg负荷量口服，并于服用氯吡格雷75 mg/d 3 d后再次测定ADP诱导的血小板聚集率。结果吸烟组与非吸烟组在性别、红细胞计数、血小板计数、血小板压积和低密度脂蛋白胆固醇等方面无显著性差异（P>0.05）。两组阿司匹林抵抗和半抵抗的总发生率为19.1%；吸烟组阿司匹林抵抗和半抵抗的发生率高于非吸烟组（25.5% vs 14.3%，P=0.027），年龄（OR=3.79，95%CI: 1.77～8.12）和吸烟（OR=1.98，95%CI: 1.18～4.43）是阿司匹林抵抗和半抵抗的独立危险因素。两组氯吡格雷抵抗发生率为19.5%，吸烟组氯吡格雷抵抗的发生率低于非吸烟组（13.2% vs 24.3%，P=0.03），吸烟是氯吡格雷抵抗的保护因素（OR=0.22，95%CI: 0.09～0.54）。结论吸烟降低阿司匹林的抗血小板效应，但增强氯吡格雷的抗血小板效应。

关键词: 吸烟, 阿司匹林抵抗, 阿司匹林半抵抗, 氯吡格雷抵抗, 心绞痛, 经皮冠状动脉介入治疗

Abstract: ObjectiveTo explore the association of smoking to the Aspirin and Clopidogrel antiplatelet in patients with stable angina after percutaneous coronary intervention (PCI). Methods241 smoking patients and 252 non-smoking patients underwent PCI for stable coronary artery disease, all patients had taken aspirin 100 mg/d for 7 d or more. The arachidonic acid (AA)- and adenosine diphosphate (ADP)-induced platelet aggregation were tested as they got in hospital. Then, they accepted Clopidogrel 300 mg as loading dose, continued with 75 mg/d for 3 d. The ADP-induced platelet aggregation were re-tested. ResultsThe incidence of aspirin resistance (AR) and aspirin semiresponder (ASR) was 19.1% in all the cases, and was 25.5% in smoking group, 14.3% in non-smoking group (P=0.027). Age (OR=3.79，95%CI: 1.77～8.12) and smoking (OR=1.98，95%CI: 1.18～4.43) were the independent risk factors of AR and ASR. The incidence of Clopidogrel resistance was 19.5% in all the cases, and was 13.2% in smoking group, 24.3% in non-smoking group (P=0.03). Smoking (OR=0.22，95%CI: 0.09～0.54) may reduce the risk of Clopidogrel resistance. ConclusionSmoking increased the risk of AR and ASR, but reduced the risk of Clopidogrel resistance.

Key words: smoking, aspirin resistance, aspirin semiresponder, Clopidogrel resistance, angina, percutaneous coronary intervention