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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
申文彬,白静,陈素芳,刘会君,李国庆,王明昭,张瑞霞,苏邵萍,王禹.双倍氯吡格雷维持剂量与替格瑞洛对慢代谢型患者的临床效果[J].中华老年多器官疾病杂志,2018,17(6):425~429
双倍氯吡格雷维持剂量与替格瑞洛对慢代谢型患者的临床效果
Clinical efficacy of ticagrelor versus double maintenance dose of clopidogrel in poor-metabolizing patients after percutaneous coronary intervention
投稿时间:2017-12-11  修订日期:2018-03-14
DOI:10.11915/j.issn.1671-5403.2018.06.095
中文关键词:  冠心病;氯吡格雷抵抗;替格瑞洛
英文关键词:coronary heart disease; clopidogrel resistance; ticagrelor
基金项目:国家自然科学基金(81670218)
作者单位E-mail
申文彬 解放军371中心医院心血管内科,新乡 453000  
白静 解放军371中心医院心血管内科,北京 100853  
陈素芳 解放军371中心医院肿瘤科,新乡 453000  
刘会君 解放军371中心医院心血管内科,新乡 453000  
李国庆 解放军371中心医院 财经处,新乡 453000  
王明昭 解放军371中心医院药械科解放军总医院 北京 100853:  
张瑞霞 解放军371中心医院心血管内科,新乡 453000  
苏邵萍 解放军371中心医院门诊部干部诊疗科,北京 100853  
王禹 解放军371中心医院心血管内科,北京 100853 wangyuheart@yeah.ne 
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中文摘要:
      目的 探讨细胞色素P450基因超家族CYP2C19慢代谢型患者使用双倍氯吡格雷维持剂量与替格瑞洛对于经皮冠状动脉介入(PCI)术后主要不良心血管事件(MACEs)发生的影响。方法 选取2014年6月至2016年9月解放军总医院心血管内科行PCI且CYP基因检测结果为慢代谢型患者205例,随机数字表法分为氯吡格雷组103例和替格瑞洛组102例,氯吡格雷组患者给予双倍维持剂量150 mg/d,3个月后更改为75 mg/d。替格瑞洛组给予180 mg负荷剂量后90 mg 2次/d的维持剂量,所有患者双联抗血小板药物服用时间均为12个月,12个月后随访结果。采用SPSS 17.0统计软件对数据进行分析,组间比较采用独立样本t检验、秩和检验、χ2检验或Fisher确切概率法。结果 2组患者年龄、性别、体质量指数(BMI)、血小板计数、估计肾小球滤过率(eGFR)、ST段抬高型心肌梗死(STEMI)、非ST段抬高型心肌梗死(Non-STEMI)、高血压、高脂血症和既往是否行PCI等差异无统计学意义(P>0.05)。氯吡格雷组和替格瑞洛组球囊预扩张压力[(12.3±2.8) vs(11.4±1.7)mmHg]和支架展开压力[(12.4±2.5) vs(11.5±2.2)mmHg]差异有统计学意义(P<0.05)。氯吡格雷组MACEs发生率较替格瑞洛组明显升高[14.6%(15/103) vs 5.9%(6/102)],差异具有统计学意义(P=0.040)。结论 慢代谢型患者使用替格瑞洛较150 mg氯吡格雷维持剂量可能会取得更优的临床效果。
英文摘要:
      Objective To compare the effects of ticagrelor versus double maintenance dose of clopidogrel in poor-metabolizing (PM) patients [with an abnormal variant of cytochrome P450 family 2 subfamily C member 19 (CYP2C19)] after percutaneous coronary intervention (PCI). Methods A total of 205 patients with verified PM by CYP gene test who underwent PCI in the cardiological department of Chinese PLA General Hospital from June 2014 to September 2016 were recruited in this study. They were randomly divided into clopidogrel group (n=103) and ticagrelor group (n=102). The patients of the clopidogrel group were given 150 mg/d clopidogre for 3 months and then 75 mg/d for the other 9 months. While those from the ticagrelor group were given a loading dosage of 180 mg ticagrelor, followed by a maintenance dosage of 90 mg, twice per day. All of the patients were given dual antiplatelet agents for 12 months, and the outcomes were analyzed after 12 months of follow-up. SPSS statistics 17.0 was used to perform the statistical analysis. Independent sample t test, rank-sum test, Chi-square test, or Fisher exact test was employed for comparison between groups. Results There were no significant differences between the 2 groups in age, sex, body mass index (BMI), platelet count, estimated glomerular filtration rate (eGFR), ratios of those suffering from ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (Non-STEMI), hypertension and hyperlipidemia, and previous intervention of PCI (P>0.05). But obvious differences were seen in balloon dilatation pressure [(12.3±2.8) vs (11.4±1.7)mmHg] and stent expansion pressure [(12.4±2.5) vs (11.5±2.2) mmHg] between the 2 groups (P<0.05). What′s more, the incidence rates of major adverse cardiovascular events (MACEs) was notably higher in the clopidogrel group than in the ticagrelor group [14.6%(15/103) vs 5.9%(6/102), P=0.040]. Conclusion Ticagrelor is superior to maintenance dose of 150 mg clopidogrel in clinical outcomes for the PM patients
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