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目的探讨急性冠状动脉综合征(ACS)患者行冠状动脉支架术后服用阿托伐他汀或普伐他汀对氯吡格雷抗血小板作用的影响。方法研究对象为150例2006年4至12月成功实施冠状动脉支架术的住院 ACS 患者,术后第1天起随机接受阿托伐他汀20 mg/d(n=50)、普伐他汀20mg/d(n=50)或无他汀(n=50)治疗。围术期抗血小板治疗为阿司匹林300 mg/d,当天氯吡格雷负荷量300 mg,继以维持量75 mg/d。观测各组患者术后第1天(基线值)及第3天的血小板膜糖蛋白P-选择素(CD62P)、血小板活化复合物(PAC-1)表达及20 μmol/L 二磷酸腺苷(ADP)诱导的血小板最大聚集率(MPAR)。结果三组患者临床及 CD62P、PAC-1和 MPAR 的基线值差异均无统计学意义。各观测指标第二次测定值与基线值的差值显示,阿托伐他汀、普伐他汀和无他汀组的ΔCD62P[(4.69±16.78)%、(1.35±10.86)%和(2.97±10.21)%]、APAC-1[(12.78±22.07)%、(8.01±21.23)%和(10.65±21.39)%]及 AMPAR](5.44±18.68)%、(7.15±19.59)%和(3.76±23.42)%]差异均无统计学意义(P>0.05)。急性心肌梗死患者亚组分析结果表明,ACD62P[(7.50±19.35)%、(3.24±11.18)%和(2.53±8.87)%]、ΔPAC-1[(13.40±24.62)%、(11.28±19.90)%和(10.11±21.29)%]及ΔMPAR[(7.56±19.11)%、(7.87±23.60)%和(6.75±23.30)%]三组间差异亦均无统计学意义(P>0.05)。结论接受冠状动脉支架术的 ACS 患者服用阿托伐他汀或普伐他汀后,短期内未发现对氯吡格雷的抗血小板作用产生显著影响。
Objective To investigate the effect of taking atorvastatin or pravastatin after coronary stenting on the antiplatelet effect of clopidogrel in patients with acute coronary syndrome (ACS). METHODS: A total of 150 inpatients with ACS undergoing coronary stenting from April 2006 to December 2006 were randomized to receive atorvastatin 20 mg / d (n = 50) and pravastatin 20 mg / d (n = 50) or no statin (n = 50). Perioperative antiplatelet therapy was aspirin 300 mg / day, clopidogrel loading 300 mg on the day followed by maintenance 75 mg / d. The levels of platelet membrane glycoprotein P-selectin (CD62P), platelet-activating complex (PAC-1) and the expression of 20 μmol / L adenosine diphosphate (ADP) on the first postoperative day ADP) induced maximum platelet aggregation rate (MPAR). Results There was no significant difference in the baseline values of clinical and CD62P, PAC-1 and MPAR between the three groups. The difference between the second measurement and the baseline value of each observation index showed that ΔCD62P (4.69 ± 16.78)%, (1.35 ± 10.86)% and (2.97 ± 10.21)% of atorvastatin, pravastatin and no statin group %, APAC-1 [(12.78 ± 22.07)%, (8.01 ± 21.23)% and (10.65 ± 21.39)% and AMPAR5.44 ± 18.68%, 7.15 ± 19.59% and 3.76 ± 23.42, %] Difference was not statistically significant (P> 0.05). A subgroup analysis of patients with acute myocardial infarction showed that ACD62P [(7.50 ± 19.35)%, (3.24 ± 11.18)% and (2.53 ± 8.87)%], ΔPAC- 1 [(13.40 ± 24.62)%, (11.28 ± 19.90) %, And (10.11 ± 21.29)%] and ΔMPAR [(7.56 ± 19.11)%, (7.87 ± 23.60)% and (6.75 ± 23.30)%], respectively. There was no significant difference between the three groups (P> 0.05). Conclusion No antiplatelet effects of clopidogrel have been found to be significantly affected in ACS patients undergoing coronary stenting in the short term after taking atorvastatin or pravastatin.