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目的:评价不同剂量氯吡格雷对经皮冠状动脉介入治疗(PCI)的冠状动脉左主干病变患者的近期疗效和安全性。方法:2006年1月至2010年1月因冠状动脉左主干病变(左主干狭窄>75%)在北京安贞医院抢救中心接受PCI、年龄≤75岁的患者为研究对象,收集其临床资料进行回顾性分析。根据服用氯吡格雷剂量将患者分为75mg剂量组(PCI治疗后第1～30天口服氯吡格雷75mg/d)和150mg剂量组(PCI治疗后第1～30天口服氯吡格雷150mg/d)。记录2组患者PCI治疗前和治疗后1、7、14、30d血小板最大聚集率和最大聚集时间,观察2组患者住院期间不良反应的发生情况。结果:共120例PCI治疗后住院患者纳入研究。其中,75mg剂量组男性46例,女性18例,平均年龄(55±7)岁;150mg剂量组男性35例,女性21例,平均年龄(50±8)岁。PCI治疗前和治疗后1、7、14、30d血小板最大聚集率和最大聚集时间,75mg剂量组分别为84%±18%和(240±48)s、81%±14%和(238±44)s、59%±12%和(210±42)s、48%±10%和(199±40)s、43%±10%和(184±30)s,150mg剂量组分别为86%±16%和(244±46)s、77%±16%和(239±46)s、51%±11%和(180±41)s、40%±10%和(166±33)s、38%±9%和(159±35)s,治疗后2组患者血小板最大聚集率和最大聚集时间均呈下降趋势,但150mg剂量组这2项指标均低于75mg剂量组(均P<0.01)。2组2项指标治疗后7、14、30d分别与治疗前、治疗后1d相比差异均有统计学意义(均P<0.05);2组血小板最大聚集率治疗后14、30d与治疗后7d相比差异有统计学意义(P<0.05);150mg剂量组血小板最大聚集率治疗后1d与治疗前相比差异有统计学意义(均P<0.05)。2组患者均未出现严重出血、再发心肌梗死、中风等心血管事件。轻微出血和腹痛、消化不良、便秘、皮疹、头晕、头痛等不良反应发生率(75mg剂量组12例、18.7%,150mg剂量组13例、23.1%)组间差异无统计学意义(χ~2=1.046,P=0.593)。结论:在冠状动脉左主干病变患者经皮冠状动脉介入治疗后的抗血栓治疗中,氯吡格雷150mg/d和75mg/d均为有效、安全的利量,但150mg/d较75mg/d能更明显地降低血小板聚集且不增加出血风险,可能更有利于减少PCI治疗后血栓的发生。
Objective: To evaluate the short-term efficacy and safety of different doses of clopidogrel in patients with left main coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS: From January 2006 to January 2010, patients undergoing PCI at age ≤75 years of age undergoing coronary artery left main coronary artery disease (left main stenosis> 75%) were enrolled in the rescue center of Beijing Anzhen Hospital. The clinical data were collected Retrospective analysis. According to the dose of clopidogrel, patients were divided into 75mg dose group (oral clopidogrel 75mg / d on the 1st ~ 30th day after PCI treatment) and 150mg dose group (oral clopidogrel 150mg / d on the 1st ~ 30th day after PCI ). The maximum platelet aggregation rate and maximal aggregation time before PCI and at 1,7,14,30th after PCI were recorded in two groups of patients. The incidence of adverse reactions during the hospitalization was observed in the two groups. Results: A total of 120 hospitalized patients after PCI were included in the study. Among them, there were 46 males and 18 females in the 75 mg dose group, with an average age of (55 ± 7) years. In the 150 mg dose group, there were 35 males and 21 females, with an average age of 50 ± 8 years. The maximal platelet aggregation and maximal aggregation time before PCI and at 1,7,14 and 30 days after PCI were 84% ± 18% and (240 ± 48) s, 81% ± 14% and (238 ± 44% ), 59% ± 12% and (210 ± 42) s, 48% ± 10%, and 199 ± 40%, 43% ± 10% and 184 ± 30% 16% and (244 ± 46) s, 77% ± 16% and (239 ± 46) s, 51% ± 11% and (180 ± 41) s, 40% ± 10% and (166 ± 33) s, 38 (P <0.01). However, the maximal aggregation rate and the maximum aggregation time of the two groups showed a decreasing trend after treatment, both of which were lower than those of the 75 mg dose group (all P <0.01) . There were significant differences between the two groups in the two indexes at 7, 14 and 30 days after treatment (P <0.05). The maximum aggregation rate of platelets at 14 and 30 days after treatment was significantly higher than that at 7 days (P <0.05). The maximum platelet aggregation rate in 150mg group had significant difference compared with before treatment (all P <0.05). No severe bleeding was found in the two groups, with recurrent cardiovascular events such as myocardial infarction and stroke. There was no significant difference in adverse reactions such as mild bleeding and abdominal pain, dyspepsia, constipation, rash, dizziness and headache (12 cases in the 75 mg dose group, 13 cases in the 18.7%, 150 mg dose group, and 23.1% = 1.046, P = 0.593). CONCLUSION: Clopidogrel 150 mg / d and 75 mg / d are effective and safe benefit in patients with left main coronary artery disease after percutaneous coronary intervention, but 150 mg / d is more effective than 75 mg / d More pronounced reductions in platelet aggregation without increasing bleeding risk may be more beneficial in reducing thrombosis after PCI.