[1]王亚辉 杨滨.血液透析对行经皮冠状动脉介入治疗的患者合用阿司匹林及氯吡格雷抗血小板聚集的影响[J].心血管病学进展,2021,(10):946.[doi:10.16806/j.cnki.issn.1004-3934.2021.10.020]
　WANG YahuiYANG Bin.Effect of Hemodialysis on the Antiplatelet Aggregation of Patients Undergoing Percutaneous Coronary Intervention Combined with Aspirin and Clopidogrel[J].Advances in Cardiovascular Diseases,2021,(10):946.[doi:10.16806/j.cnki.issn.1004-3934.2021.10.020]
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血液透析对行经皮冠状动脉介入治疗的患者合用阿司匹林及氯吡格雷抗血小板聚集的影响()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2021年10期
页码:
946
栏目:
论著
出版日期:
2021-10-25

文章信息/Info

Title:
Effect of Hemodialysis on the Antiplatelet Aggregation of Patients Undergoing Percutaneous Coronary Intervention Combined with Aspirin and Clopidogrel
作者:
王亚辉1 杨滨 1; 2
山西医科大学,山西 太原 030001;2.山西医科大学第二医院心血管内科,山西 太原 030001)
Author(s):
WANG Yahui1YANG Bin1; 2
Shanxi Medical University,Taiyuan 030001, Shanxi,China; 2. Department of Cardiology,Second Hospital of Shanxi Medical University,Taiyuan 030001, ShanxiChina)
关键词:
血液透析; 阿司匹林; 氯吡格雷; 抗血小板治疗; 治疗后血小板高反应性
Keywords:
Hemodialysis; Aspirin; Clopidogrel; Antiplatelet therapy; High on-treatment platelet reactivity
DOI:
10.16806/j.cnki.issn.1004-3934.2021.10.020
摘要:
目的 探讨血液透析（HD）对经皮冠状动脉介入治疗（PCI）后患者合用阿司匹林和氯吡格雷抗血小板聚集的影响，为临床PCI后HD患者的抗血小板治疗提供指导。方法 选取2020年1—10月于山西医科大学第二医院住院的行PCI的HD患者23例，所有患者均给予阿司匹林和氯吡格雷治疗，检测并分析HD前后血小板聚集率。根据二磷酸腺苷诱导后血小板聚集率是否＞55%，分为氯吡格雷治疗后血小板高反应组（HPR）与血小板低反应组（LPR），分析导致血小板高反应性的危险因素，同时比较两组6个月主要心血管不良事件（MACE）发生率。结果 经花生四烯酸诱导的HD前后血小板聚集率分别为7.7%±6.9%和13.2%±8.6%，经二磷酸腺苷诱导的HD前后血小板聚集率分别为32.0%±17.2%和40.6%±19.0%，HD后两种诱导剂诱导的血小板聚集率均明显升高，差异均具有统计学意义（P＜0.01）；并且透析前有6例（26.1%）患者表现为HPR，而透析后有9例（39.1%）患者表现为HPR。高脂血症、肾小球滤过率升高与HPR相关，具有统计学意义（P＜0.05）。HPR组的MACE发生率为22.2%，明显高于LPR组的7.1%，但差异无统计学意义（P＞0.05）。结论 HD后患者血小板聚集率升高，表现出很高的HPR发生率，导致阿司匹林和氯吡格雷的抗血小板聚集疗效降低，其中高脂血症和肾小球滤过率升高与HPR发生相关。在HD患者中，HPR患者的MACE发生率明显高于LPR患者，但无统计学意义。
Abstract:
Objective To explore the effect of hemodialysis on the anti-platelet aggregation effect of aspirin and clopidogrel in patients after percutaneous coronary intervention(PCI). Provide guidance for the antiplatelet therapy of hemodialysis patients after PCI. Methods 23 cases patients with chronic kidney disease on maintenance hemodialysis and coronary heart disease from January to October 2020 were collected. All patients were treated with aspirin and clopidogrel. Detect and analyze the platelet aggregation rate before and after hemodialysis. According to whether the platelet aggregation rate after adenosine diphosphate induction is >55% ,it is divided into high on-treatment platelet reactivity group (HPR) and low on-treatment platelet reactivity group (LPR) after clopidogrel treatment. Analysis of risk factors that lead to high on-treatment platelet reactivity. Simultaneously compare the incidence of adverse cardiovascular events(MACE) between the two groups at 6 months. Results The platelet aggregation rates of arachidonic acid-induced before and after hemodialysis were 7.7%±6.9% and 13.2%±8.6%. The platelet aggregation rates of adenosine diphosphate-induced before and after hemodialysis were 32.0%±17.2% and 40.6%±19.0%.The difference were statistically significant. And before dialysis,6 patients(26.1%) showed high on-treatment platelet reactivity,while after dialysis,9 patients (39.1%) showed high on-treatment platelet reactivity. Hyperlipidemia and increased glomerular filtration rate are related to HPR,which is statistically significant. The incidence of MACE in the HPR group was 22.2% significantly higher than that in the LPR group 7.1%,but the difference was not statistically significant. Conclusion The platelet aggregation rate of patients after hemodialysis is increased,showing a high incidence of HPR,resulting in a decrease in the anti-platelet aggregation efficacy of aspirin and clopidogrel. Hyperlipidemia and increased glomerular filtration rate are related to the occurrence of HPR. Among hemodialysis patients ,the incidence of MACE in HPR patients was significantly higher than that in LPR patients,but it was not statistically significant

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更新日期/Last Update: 2021-12-02