2021 年第 2 期 第 16 卷

急性冠状动脉综合征患者替格瑞洛治疗后残余血小板高反应性的影响因素研究

Influencing factors of residual high platelet reactivity in patients with acute coronary syndrome after ticagrelor treatment

作者：王悦刘倍倍陈蕾蕾王越田磊王志强张晓江陈青吴小凡

英文作者：Wang Yue Liu Beibei Chen Leilei Wang Yue Tian Lei Wang Zhiqiang Zhang Xiaojiang Chen Qing Wu Xiaofan

单位：首都医科大学附属北京安贞医院心内科100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性冠状动脉综合征；替格瑞洛；血小板高反应性

英文关键词：Acutecoronarysyndrome;Ticagrelor;Highplateletreactivityfan

• 摘要：

• 目的 探讨急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后给予替格瑞洛治疗，出现残余血小板高反应性(HPR)的影响因素。方法 连续入选2017年1月至2018年12月于首都医科大学附属北京安贞医院行PCI术的ACS患者446例，均于PCI术后给予阿司匹林(100 mg/次，1次/d)联合替格瑞洛(90 mg/次，2次/d)治疗1个月。采用光比浊法测量腺苷二磷酸诱导的血小板聚集率。血小板聚集率≥46.0%为残余HPR。根据患者服用替格瑞洛1个月后是否发生残余HPR将其分为HPR组(45例)和非HPR组(401例)。比较2组患者一般临床资料、病变和手术特征及实验室检查等指标。采用多因素Logistic回归方法分析残余HPR的影响因素。结果 HPR组患者高龄(年龄≥65岁)、糖尿病、缺血性卒中的比例均大于非HPR组［44.4%(20/45)比28.2%(113/401)、42.2%(19/45)比27.4%(110/401)、15.6%(7/45)比6.0%(24/401)］，差异均有统计学意义(均P＜0.05)，而2组其他基线特征比较，差异均无统计学意义(均P＞0.05)。多因素Logistic回归分析结果显示，高龄(比值比=2.47，95%置信区间：1.21～5.06，P=0.01)、糖尿病(比值比=2.12，95%置信区间：1.07～4.23，P=0.03)和缺血性卒中(比值比=3.26，95%置信区间：1.20～8.86，P=0.02)是接受PCI治疗的ACS患者替格瑞洛治疗后残余HPR的独立危险因素。结论 高龄、合并糖尿病及缺血性卒中是接受PCI治疗的ACS患者替格瑞洛治疗后残余HPR的影响因素。

• Objective To investigate the influencing factors of residual high platelet reactivity (HPR) after ticagrelor treatment  in patients with acute coronary syndrome (ACS) treated with  percutaneous coronary intervention (PCI). Methods  A total of 446 ACS patients treated with PCI in Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2018 were enrolled. All patients were given aspirin (100 mg, once a day) combined with ticagrelor (90 mg, twice a day) for 1 month after PCI. Optical heterometry method was used to measure platelet aggregation rate induced by adenosine diphosphate. The residual HPR was defined as platelet aggregation rate≥46.0%. The patients were divided into HPR group (45 cases) and non-HPR group (401 cases) according to the occurrence of residual HPR. The clinical data, lesions and surgery characteristics, laboratory examination and other indexes were compared between the two groups. Multivariate Logistic regression was used to analyzed the influencing factors of residual HPR. Results  The proportions of eld (age≥65 years), diabetes mellitus and ischemic stroke in patients of HPR group were higher than those of non-HPR group［44.4%(20/45) vs 28.2%(113/401), 42.2%(19/45) vs 27.4%(110/401), 15.6%(7/45) vs 6.0%(24/401)］(all P＜0.05). There were no significant differences in other basic characteristics between the two groups (all P＞0.05). Multivariate Logistic regression analysis showed that eld ［odds ratio (OR)=2.47, 95% confidence interval(CI):1.21-5.06, P=0.01］, diabetes mellitus (OR=2.12, 95%CI:1.07-4.23, P=0.03), and ischemic stroke (OR=3.26, 95%CI:1.20-8.86, P=0.02) were independent risk factors of residual HPR after ticagrelor treatment in ACS patients treated with PCI. Conclusion Eld, complicated with diabetes mellitus and ischemic stroke are the influencing factors of residual HPR after ticagrelor treatment in ACS patients treated with PCI.