张强,马长生,聂绍平,吕强,康俊萍,杜昕,张崟,贾长琪,胡荣,刘新民,刘小慧,董建增,吴学思

• 1:首都医科大学附属北京安贞医院心内科
• 2:南京医科大学附属苏州医院
• 3:苏州市立医院(本部)心内科

摘要(Abstract)：

目的了解置入药物洗脱支架(DES)患者术后的氯吡格雷治疗状况,探讨不同的疗程对晚期支架血栓(ST)发生的影响。方法连续入选2003年7月1日至2005年6月30日期间接受PCI并置入DES,且术后30天存活的患者,根据术后氯吡格雷的疗程将患者分为4组,即组1(<3月)、组2(3～6月)、组3(6～12月)和组4(>12月)。记录所入选患者住院期和随访期内临床资料,并根据ARCDublin定义判定ST事件。结果共2704例患者符合研究条件入选本研究。与组4患者相比,组1、组2的患者中合并糖尿病者较多,平均左室射血分数(LVEF)值较低,而ST段抬高型心肌梗死(STEMI)者较少,冠状动脉病变在各组之间无显著差异,但所置入DES数目较少。组1中断氯吡格雷治疗的患者中,自行停药比例较高;而组3中断氯吡格雷治疗的患者中,因医嘱停药的比例较高。多因素回归分析显示,影响患者提前中断氯吡格雷治疗的因素为:合并糖尿病(OR=1.542,95%CI1.184～2.008,P=0.001)和所置入DES的数目(OR=0.790,95%CI0.709～0.880,P<0.001)。晚期和晚晚期ST发生率在4组患者间差异有统计学意义(6.1%比1.2%比0.8%比0%,P<0.001),其中组3的ST发生率也较组4升高(0.8%比0%,P=0.013)。结论在临床实践中,有近3/4的患者在DES置入后的氯吡格雷疗程不足12个月。合并糖尿病和置入DES的数目是氯吡格雷疗程的独立影响因素。晚期和晚晚期ST的风险随氯吡格雷疗程的延长而降低。

关键词(KeyWords)： 支架;血小板聚集抑制剂;冠状动脉血栓形成

Abstract:

Keywords:

基金项目(Foundation): 国家重点基础研究发展规划(973计划)资金资助项目(2003CB517103)

作者(Author): 张强,马长生,聂绍平,吕强,康俊萍,杜昕,张崟,贾长琪,胡荣,刘新民,刘小慧,董建增,吴学思

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