抑郁对不稳定型心绞痛患者择期PCI后氯吡格雷药物反应的影响研究(1)
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【摘要】 目的 探讨抑郁对不稳定型心绞痛(USP)患者择期经皮冠状动脉介入治疗(PCI)后氯吡格雷药物反应的影响。方法 选取240例成功行PCI术的患者,分为抑郁组(117例)和非抑郁组(123例),PCI术前2 h给予氯吡格雷600 mg顿服,术后75 mg/d维持。分别于术前1 d内,术后1 d、5 d和1个月采血,以比浊法测定血小板凝集率(PAG),流式细胞仪测定血小板表面P选择素(CD62P)水平;比较两组患者随访12个月的重要心血管事件和非致死性卒中发生率。结果 PCI术前抑郁组比非抑郁组有较高的血小板聚集率(q=6.7613,P<0.01)和P选择素水平(q=5.9827,P<0.01),并且抑郁程度和血小板反应性存在线性关系(r=0.513,P<0.05)。术后1 d,5 d两组比较,血小板聚集率(q=7.9837,P<0.01; q=6.8931,P<0.01)和P选择素水平差异有统计学意义(q=11.8960,P<0.01; q=7.4420,P<0.01),并且氯吡格雷抵抗率两组差异有统计学意义(χ2值为6.853,P=0.009; χ2值为8.455,P=0.004),术后1个月持续抑郁组仍有较高的氯吡格雷抵抗率(χ2值为4.861,P=0.027)。结论 抑郁增强血小板凝集率和血小板活化程度,影响患者氯吡格雷药物反应。
【关键词】不稳定型心绞痛;经皮冠状动脉介入治疗;血小板聚集率;血小板P选择素;抑郁
The clinical study on the effect of depression on the antiplatelet effect of clopidogrel in patients with USP treated with elective PCI
ZHU Wei-yong,Ding Fa-ming,Zhang Xin-li,et al.Department of Cardiology,The Second affiliated Hospital of Medical College Qingdao University 266042,Qingdao,China
【Abstract】 Objective To evaluate the significance of depression on the effect of depression on the antiplatelet effect of clopidogrel in patients with USP treated with elective PCI.Methods The study group consisted of 240 patients with USP treated with elective PCI that was divided into two groups:Group A-117 patients with depression,including 81 persistently depressed patients and 36 remittent depressed patients,group B-123 persistently nondepressed patients,and the control group consisted of 20 healthy subjects.An ADP-induced light-transmittance aggregometry(Chronolog Corp,USA)was used to measure the antiplatelet effect of clopidogrel,and the activated platelets CD62P was studied by flow cytometry.All of them were measured at baseline and at 1day,5day and 1 month after PCI respectively.Results Preprocedural platelet aggregation andCD62P were higher in patients with depression than those in patients without depression.Post-procedural levels at day 1 and 5day showed a more decrease in patients without depression than in depression patients compared with preprocedural levels.The Patients with depression showed more clopidogrel resistance than patients without depression at 1day and 5day after PCI ......
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