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目的:综述近年来国内外学者对阿司匹林抵抗与氯吡格雷抵抗的研究结果,为临床合理用药提供循证依据。方法:检索国内外的相关文献,进行系统的文献整理和综合分析。结果:各研究间由于研究对象、研究方案的设计、使用的检测血小板功能的方法及各检测方法对抗血小板药物抵抗的定义不同等,研究结果存在差异。其中与抗血小板药物抵抗相关的可能临床因素包括患者的性别、合并疾病、合并用药、相关实验室检查等,与抗血小板药物抵抗相关的可能分子机制包括与阿司匹林抵抗相关的基因多态性位点(PTGS1和PLA2)和与氯吡格雷抵抗相关的基因多态性位点(ABCB1、CYP2C19、CYP3A4、CYP3A5和P2Y12)。结论:临床医生可以从临床因素和基因多态性两方面评估患者发生阿司匹林抵抗与氯吡格雷抵抗的风险,并制定合理的给药方案。
OBJECTIVE: To summarize the research results of aspirin resistance and clopidogrel resistance by domestic and foreign scholars in recent years, and provide an evidence-based basis for clinical rational drug use. Methods: Retrieve the relevant literature at home and abroad, systematic literature review and comprehensive analysis. Results: There was a difference in the research results among different research groups because of the research object, the design of the research protocol, the method of testing platelet function used and the different definitions of antiplatelet resistance of each test method. Among the possible clinical factors related to anti-platelet drug resistance, such as patient’s sex, co-morbidities, drug combination, related laboratory tests, etc., possible molecular mechanisms associated with antiplatelet drug resistance include genetic polymorphism sites related to aspirin resistance (PTGS1 and PLA2) and genetic polymorphisms (ABCB1, CYP2C19, CYP3A4, CYP3A5 and P2Y12) associated with clopidogrel resistance. CONCLUSIONS: Clinicians can assess the risk of aspirin resistance and clopidogrel resistance in both clinical and genetic polymorphisms and develop a rational dosing regimen.