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目的:研究急性冠脉综合征(ACS)患者对阿司匹林联合氯吡格雷双重抗血小板治疗的反应并探讨药物抵抗与血小板COX-1基因A842G位点的相关性。方法:154例ACS患者,以花生四烯酸(AA)作为诱导剂测定血小板聚集率(PAG)。ELISA法测定尿11-脱氢-血栓素B2(11-DH-TXB2)水平。分析血小板COX-1基因A842G位点的基因型。计算患者2周内主要临床心脏事件(MACE)发生率。结果:①154例ACS患者PAG及尿11-DH-TXB2水平均明显升高,且急性心肿梗死(AMI)患者高于不稳定性心绞痛(UAP)患者,组间比较存在统计学差异(t=2.994,P<0.01;t=2.053,P<0.01);②双重抗血小板药物抵抗(AR)6例,抵抗发生率为3.90%;③COX-1基因A842G位点基因型AA型150例(97.40%),AG型4例(2.60%)。AR患者6例,其中AA型患者5例(83.33%),AG型患者1例(16.67%),组间比较存在统计学差异(χ2=43.560,P<0.01);④2周内AR组MACE率33.33%(2例),AS组4.05%(6例),组间比较存在统计学差异(χ2=22.73,P<0.01)。结论:①ACS患者存在不同程度的血小板活化状态,且AMI患者高于UAP患者,高血小板活化状态能引起更为严重的急性心脏事件;②COX-1基因A842G位点单核苷酸多态性可能与AR的发生有关,含有G突变基因患者更易发生AR;③AR患者更易发生心脏临床事件。
Objective: To study the response of aspirin plus clopidogrel dual antiplatelet therapy in patients with acute coronary syndrome (ACS) and to explore the relationship between drug resistance and platelet COX-1 gene A842G. Methods: 154 cases of ACS patients with arachidonic acid (AA) as an inducer of platelet aggregation rate (PAG). Urinary 11-dehydro-thromboxane B2 (11-DH-TXB2) levels were measured by ELISA. Analysis of platelet COX-1 gene A842G genotype. The incidence of major clinical cardiac events (MACE) within 2 weeks was calculated. Results: ① The levels of PAG and urinary 11-DH-TXB2 were significantly increased in 154 patients with ACS, and the patients with acute myocardial infarction (AMI) were higher than those with unstable angina pectoris (UAP). There was significant difference between the two groups (t = 2.904, P <0.01; t = 2.053, P <0.01); ②The double antiplatelet drug resistance (AR) in 6 cases, the resistance rate was 3.90%; ③COX-1 gene A842G genotype AA 150 cases (97.40% ), AG type in 4 cases (2.60%). There were 6 cases of AR patients, including 5 cases (83.33%) of AA patients and 1 case (16.67%) of AG patients with statistical difference (χ2 = 43.560, P <0.01) 33.33% (2 cases), AS group 4.05% (6 cases). There was significant difference between two groups (χ2 = 22.73, P <0.01). Conclusions: ① There are different degrees of platelet activation in ACS patients, and the AMI patients are higher than those in UAP patients. The activation of platelet can cause more serious acute cardiac events. ② The single nucleotide polymorphism of COX-1 gene A842G may be associated with AR occurred in patients with G mutation gene more prone to AR; ③ AR patients more prone to cardiac clinical events.