【摘要】：目的:探討通過血栓彈力圖對接受PCI術(shù)的維、漢民族冠心病患者的抗血小板藥物的血小板抑制率檢測,分析不同民族間對抗血小板藥物抵抗率是否存在差異,探討抗血小板藥物抵抗是否影響患者預(yù)后。方法:選取2015年8月至2016年10月在新疆維吾爾自治區(qū)人民醫(yī)院心內(nèi)科擇期接受PCI治療的冠心病患者128例,按照民族差異分為維吾爾族組68例和漢族組60例,所有患者于PCI術(shù)后抽血化驗血栓彈力圖,檢測其AA誘導(dǎo)的血小板抑制率,ADP誘導(dǎo)的血小板抑制率,ADP誘導(dǎo)的凝血塊強度(MAADP).分析不同民族間血小板抑制率是否存在差異。對所有患者出院后進行3個月的隨訪,記錄其主要不良心血管事件(MACE)的發(fā)生情況。分析抗血小板藥物抵抗與預(yù)后關(guān)系。結(jié)果:兩組患者年齡、性別、個人史、相關(guān)疾病史無統(tǒng)計學(xué)意義(P0.05)�？偣灿�22例(17.19%)患者發(fā)生氯吡格雷抵抗,其中漢族患者6例(10.00%),維族患者16例(23.53%),差異有統(tǒng)計學(xué)意義(P0.05)。共有13例(10.16%)患者發(fā)生阿司匹林抵抗,其中漢族患者6例(10.00%),維患者7例(10.29%),差異無統(tǒng)計學(xué)意義(P=0.956)。MAADP異常(≥50mm)的共有16人(12.50%),其中漢族患者中3人(5.00%)MAADP異常,維吾爾族患者中13人異常(19.12%),差異有統(tǒng)計學(xué)意義(P0.05)。3個月隨訪當(dāng)中共有14位患者發(fā)生主要心血管不良事件(MACE),其中氯吡格雷反應(yīng)正常的患者中發(fā)生MACE事件有8人,發(fā)生率為7.55%,而氯吡格雷抵抗的患者中發(fā)生MACE事件的有6人,發(fā)生率為27.27%,差異有統(tǒng)計學(xué)意義(P0.05)。阿司匹林反應(yīng)正常的患者中發(fā)生MACE事件的有11人,MACE事件發(fā)生率為9.57%,阿司匹林抵抗的13例患者中有3人發(fā)生MACE事件,發(fā)生率為23.08%,差異無統(tǒng)計學(xué)意義(P0.05)。MAADP正常的患者中發(fā)生MACE事件的有9人,發(fā)生率為8.04%,MAADP異常的患者中發(fā)生MACE事件的有5人,發(fā)生率為31.25%,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:PCI術(shù)后維、漢民族患者之間阿司匹林抵抗無差異,而氯吡格雷抵抗存在差異,且維吾爾族患者氯吡格雷抵抗發(fā)生率較漢族患者高。PCI術(shù)后阿司匹林抵抗不增加MACE事件的發(fā)生率,而氯吡格雷抵抗增加MACE事件的發(fā)生率。PCI術(shù)后MAADP≥50mm時增加MACE事件的發(fā)生率。
[Abstract]:Objective: to investigate the platelet inhibition rate of antiplatelet drugs in patients with coronary heart disease (CHD) in Han nationality by thromboelastography, and to analyze whether there are differences in anti-platelet drug resistance rate among different nationalities. To investigate whether anti-platelet drug resistance affects the prognosis of patients. Methods: from August 2015 to October 2016, 128 patients with coronary heart disease received PCI treatment in cardiology department, Xinjiang Uygur Autonomous region people's Hospital, and were divided into Uygur group (68 cases) and Han nationality group (60 cases) according to their ethnic differences. Thromboelastograms were taken from all patients after PCI. The platelet inhibition rate induced by AA was measured. The platelet inhibition rate induced by ADP and clot strength (MAADP). Induced by ADP were measured. To analyze whether there are differences in platelet inhibition rate among different nationalities. All patients were followed up for 3 months after discharge to record the occurrence of major adverse cardiovascular events (MACE). To analyze the relationship between antiplatelet drug resistance and prognosis. Results: there was no significant difference in age, sex, personal history and related disease history between the two groups (P0.05). Clopidogrel resistance was found in 22 patients (17.19%), including 6 Han patients (10.00%) and 16 Uygur patients (23.53%). The difference was statistically significant (P0.05). Aspirin resistance was found in 13 patients (10.16%), including 6 patients (10.00%) in Han nationality and 7 cases (10.29%) in patients with Uygur. There was no significant difference (P < 0.956). There were 16 cases (12.50%) with abnormal MAADP and 3 cases (5.00%) with abnormal MAADP in Han nationality. 13 (19.12%) of Uygur patients were abnormal, the difference was statistically significant (P0.05). During the 3-month follow-up, there were 14 patients with major cardiovascular adverse events (MACE),) and 8 patients with normal clopidogrel reaction (clopidogrel). The incidence of clopidogrel resistance was 7.55 and 6 patients with clopidogrel resistance had MACE events, the incidence was 27.27, the difference was statistically significant (P0.05). The incidence of MACE events in 11 patients with normal aspirin reaction was 9.57, and that in 13 patients with aspirin resistance was 3. The incidence rate was 23.08, the difference was not statistically significant (P0.05). There were 9 cases of MACE events in the patients with normal MAADP, and 5 cases had the incidence of MACE events in the patients with abnormal MAADP of 8.04%, the incidence rate was 31.25%, the difference was statistically significant (P0.05). Conclusion there is no difference in aspirin resistance between Han nationality patients and clopidogrel resistance. The incidence of clopidogrel resistance in Uygur patients was higher than that in Han patients. Aspirin resistance after PCI did not increase the incidence of MACE events, while clopidogrel resistance increased the incidence of MACE events.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

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