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首页> 中文期刊> 《中华心血管病杂志》 >VerifyNow-P2Y12系统评估氯吡格雷血小板抑制性的临床应用

VerifyNow-P2Y12系统评估氯吡格雷血小板抑制性的临床应用

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目的 临床评估常规剂量氯吡格雷的血小板抑制性,探讨氯吡格雷低反应的临床特征及其预测因素.方法 人选99例接受冠状动脉介入治疗并规律服用氯吡格雷1周以上的冠心病患者,通过VerifyNow-P2Y12系统检测氯吡格雷对血小板的抑制状况,并分别以血小板基线活性、P2Y12反应单位(PRU,代表血小板残余活性)及血小板抑制率来表示.详细记录所有入选者抗血小板药物的服用剂量和疗程、合并用药情况以及临床基线特征等.本研究以PRU≤240为标准,将氯吡格雷服用后血小板反应性分为正常反应及低反应(即氯吡格雷抵抗),后者进一步根据基线活性及抑制率水平分为Ⅰ型(即基线相关型,假性抵抗)、Ⅱ型(抑制率相关型,真性抵抗)和Ⅲ型(复合型)3种亚型.结果 99例受检患者中氯吡格雷抵抗者48例(48.5％),其中Ⅰ、Ⅱ和Ⅲ型抵抗分别为9例(9.1％)、27例(27.3％)和12例(12.1％)；与男性相比,女性患者血小板基线活性较高(P＜0.01),同时PRU增高的人群比例较高(P＜0.01),女性为Ⅰ型抵抗的预测因素(OR=6.500, 95％ CI2.295 ～ 18.407,P＜0.01)；而体质指数(BMI) ＞24 kg/m2与氯吡格雷血小板抑制率显著相关(P＜0.05),提示为Ⅱ型抵抗的预测因素( OR=3.207,95％CI1.375 ～7.485,P＜0.01).年龄、高血压、糖尿病、吸烟、高脂血症、C反应蛋白、合用泮托拉唑等因素与基线活性及血小板抑制率均无明显相关性.结论 VerfyNow-P2Y12系统检测提示,氯吡格雷Ⅰ型抵抗因血小板基线活性过高所致,女性为高基线活性的独立预测因素；Ⅱ型抵抗因血小板抑制率过低所致,与氯吡格雷药理作用减弱有关,超重为其影响因素；Ⅲ型抵抗同时存在高基线及低抑制率的特征；年龄、高血压、糖尿病、吸烟、高脂血症、C反应蛋白及合用质子泵抑制剂泮托拉唑等因素与氯吡格雷抵抗的发生无明显相关性.%Objective To evaluate the platelet inhibition efficacy in patients under regular maintenance dose of clopidogrel by VerifyNow-P2Y12 assay and explore the clinical characteristics of clopidogrel non-responders and related predicting factors.Methods A total of 99 patients underwent percutaueous coronary intervention procedure and receiving clopidogrel in regular maintenance dose for at least 1 week were enrolled. Platelet reactivity,including baseline,P2Y12 reaction unit (PRU),and platelet inhibition rate were measured with VeifyNow-P2Y12 assay. The dosage of anti-platelet drugs,combination with any other drugs,clinical characters in baseline of all enrolled patients were analyzed.PRU ≤240 was used as cut-off to identify clopidogrel responder and clopidogrel non-responder.In the nonresponder group,patients were further separated into 3 sub-groups (types) according to the baseline and platelet inhibition rate:type Ⅰ with high baseline,high inhibition rate,representing false non-responder;type Ⅱ with low inhibition rate,representing true non-responder and type Ⅲ mixed type.Results In this study,48 of 99 patients were found to be clopidogrel non-responder (48.5％). The ratio of type Ⅰ,type Ⅱ and type Ⅲ in the non-responder group was 9.1％ ( n =9 ),27.3 ％ ( n =27 ),and 12.1％ ( n =12 ),respectively.Baseline platelet value in female patients was significantly higher than in males ( P ＜ 0.01 ),number of females with high PRU also is higher than males (P ＜ 0.01 ),female gender was a predict factor for type Ⅰ nnn-responder( OR =6.5,95％ CI 2.295 - 18.407,P ＜ 0.01 ). BMI ＞ 24 kg/m2 was a risk factor for clopidogrel non-responder ( P ＜ 0.05 ),and may be regarded as a predict factor for type Ⅱ nonresponder(OR =3.207,95％ CI 1.375 - 7.485,P ＜ 0.01 ). Age,hypertension,diabetics,smoking,hyperlipidemia,CRP and pantoprazole use do not show significant correlation with baseline and platelet inhibition rate.Conclusions Clopidogrel responses could be reliably detected by VerifyNow-P2Y12 assay.Female gender and high body weigbt are independent risk factors for clopidogrel non-responses.

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