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目的研究急性冠状动脉综合征(ACS)患者在抗血小板治疗(阿司匹林和氯吡格雷)后再联用阿托伐他汀对对氯吡格雷羧酸衍生物血浓度和血小板聚集率的影响。方法健康受试者(25例)口服拜阿司匹林肠溶片、氯吡格雷和阿托伐他汀(100,75,20 mg·d-1),第5 d停用阿托伐他汀,继续口服氯吡格雷和阿司匹林。ACS患者(66例)在常规治疗基础上,与健康受试者有相同的治疗方案。分别于第5,9 d用HPLC-MS/MS测量氯吡格雷羧酸衍生物血浓度,用流式细胞仪测定血小板聚集率。结果在抗血小板治疗加阿托伐他汀治疗与仅抗血小板治疗,氯吡格雷羧酸衍生物血浓度:在健康组分别为(5.76±0.87),(5.67±0.88)ng·dL-1;在ACS患者分别为(5.96±0.87),(5.86±0.97)ng·dL-1,两者间差异均无统计学意义(P=0.35,0.12)。提示联用他汀和氯吡格雷并不影响氯吡格雷羧酸衍生物血浓度,两药间无相互作用。在同样条件下,血小板聚集率:健康组分别为(44.25±16.37)%,(47.61±16.67)%;患者组分别为(47.70±15.07)%,(47.02±15.45)%,两者间差异均无统计学意义(P=0.08,0.62),表明2组联用氯吡格雷与阿托伐他汀均不影响氯吡格雷的抗血小板治疗效果。结论本研究未检测到血氯吡格雷原药成分;氯吡格雷和阿托伐他汀间无相互作用。
Objective To investigate the effect of atorvastatin on the plasma concentrations of clopidogrel carboxylic acid derivatives and platelet aggregation in patients with acute coronary syndrome (ACS) after antiplatelet therapy (aspirin and clopidogrel). Methods Healthy subjects (25 cases) were given oral aspirin, clopidogrel and atorvastatin (100, 75 and 20 mg · d-1) respectively. Atorvastatin was stopped on the 5th day, and oral chlorine Pigeon and aspirin. ACS patients (66 patients) had the same treatment regimen as healthy subjects on a routine treatment basis. Blood concentrations of clopidogrel carboxylic acid derivatives were measured by HPLC-MS / MS on day 5 and 9, and platelet aggregation rate was measured by flow cytometry. Results In the antiplatelet treatment plus atorvastatin treatment with antiplatelet therapy alone, the plasma concentrations of clopidogrel carboxylic acid derivatives were (5.76 ± 0.87) and (5.67 ± 0.88) ng · dL -1 in the healthy group, respectively ACS patients were (5.96 ± 0.87) and (5.86 ± 0.97) ng · dL-1, respectively. There was no significant difference between the two groups (P = 0.35,0.12). Prompt combination of statins and clopidogrel does not affect the plasma concentration of clopidogrel carboxylic acid derivatives, no interaction between the two drugs. Under the same conditions, the platelet aggregation rate was (44.25 ± 16.37)% and (47.61 ± 16.67)% respectively in the healthy group and (47.70 ± 15.07)% and (47.02 ± 15.45)% respectively in the healthy group There was no statistical significance (P = 0.08, 0.62), indicating that no combination of clopidogrel and atorvastatin in both groups affected the antiplatelet effect of clopidogrel. Conclusion No clopidogrel content was detected in this study. There was no interaction between clopidogrel and atorvastatin.