世界中医药

作者	单位
王宇平1，郭金成1，苏平2，冯玉宝2，徐荣1，蔡宜婷1	1 首都医科大学附属北京潞河医院心内科，北京，101199； 2 内蒙古自治区鄂尔多斯市中心医院心内科，鄂尔多斯，017000

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中文摘要:

目的：评价银杏酮酯联合常规双联抗血小板方案在急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后氯吡格雷抵抗时的应用价值。方法：选取2017年1月至12月在首都医科大学附属北京潞河医院共有1 560例ACS患者行PCI手术,按就诊顺序纳入489例经血栓弹力图证实存在氯吡格雷抵抗的患者进行临床观察,根据不同抗血小板方案将其分为A组（n=127）、B组（n=209）和C组（n=153）。A组采用阿司匹林+氯吡格雷强化的抗血小板治疗方案，B组采用阿司匹林+替格瑞洛的抗血小板治疗方案，C组采用阿司匹林+氯吡格雷+银杏酮酯的抗血小板治疗方案。调整用药后2周复查TEG，观察3组腺苷二磷酸抑制率（ADP%）、花生四烯酸抑制率（AA%），比较用药期间药物不良反应发生率(ADR)、3组抗血小板治疗的药物总费用（元），考察随访6个月时主要不良心血管事件（MACE）发生率。结果：调整用药后2周复查TEG发现，3组ADP%、AA%均较其调整用药前明显改善（P<0.05），3组组间比较差异有统计学意义（P>0.05），其中C组改善最佳（P<0.05）。3组抗血小板治疗药物总费用分别是：A组440.30元，B组305.20元，C组307.44元。与B组比较，C组药物总费用没有明显增加。持续随访6个月,3组总ADR发生率分别是：A组为14.38%（22/127），B组为30.62%（61/209），C组为7.19%（11/153）,3组比较差异有统计学意义（P<0.05），其中C组皮肤黏膜轻度出血发生率更低（P<0.05）。3组MACE发生率分别是：A组4.72%（6/127），B组0.48%（1/209），C组0.65%（1/153），3组比较差异无统计学意义（P>0.05）。结论：银杏酮酯联合常规阿司匹林和氯吡格雷双联抗血小板治疗可有效改善ACS患者PCI术后出现的氯吡格雷抵抗，可显著降低血小板的聚集活性、降低出血率及近期MACE事件,且不会增加药物费用，故推荐这一方案在临床合理应用。

English Summary:

To evaluate the value of ginkgolide ester combined with conventional dual antiplatelet regimen in clopidogrel resistance in patients with acute coronary syndrome(ACS）after percutaneous coronary intervention(PCI).Methods：From January to December 2017,560 patients with ACS underwent PCI in Luhe Hospital of Beijing were selected.489 patients with clopidogrel resistance confirmed by thromboelastography were enrolled in this study according to the order of visit.They were divided into 3 study groups according to different antiplatelet regimens.Group A：127 cases were treated with aspirin plus clopidogrel intensified antiplatelet therapy.Group B：209 patients received antiplatelet therapy with aspirin plus tiryllo.Group C：153 cases were treated with aspirin plus clopidogrel plus ginkgolone.TEG was reexamined 2 weeks after adjusting the medication.Inhibition rate of adenosine diphosphate(ADP%）and inhibition rate of arachidonic acid(AA%）were observed in 3 groups.The incidence of adverse drug reactions(ADR）during 2 weeks of medication observation was compared among the 3 groups.The total drug cost of platelet therapy(RMB）and the incidence of MACE(Major adverse cardiovascular events）at 6 months of follow-up were investigated.Results：Two weeks after adjustment,TEG showed that ADP% and AA% in the 3 groups were significantly improved compared with those before adjustment(P<0.05),and there was significant difference among the 3 groups(P>0.05).The improvement in group C was better(P<0.05).The total cost of antiplatelet drugs in the 3 groups was 440.30 in group A,305.20 in group B and 307.44 in group C.Compared with group B,the total cost of antiplatelet drugs in group C did not increase significantly.During the 6 months followed-up period,the total ADR incidence of the 3 groups was 14.38%(22/127）in group A,30.62%(61/209）in group B and 7.19%(11/153）in group C,and there was significant difference among the 3 groups(P>0.05).The incidence of mild skin and mucosal bleeding was lower in group C(P<0.05).The incidence of MACE was 4.72%(6/127）in group A,0.48%(1/209）in group B and 0.65%(1/153）in group C.There was no significant difference among the 3 groups(P>0.05).Conclusion：Ginkgo bilobate combined with conventional aspirin and clopidogrel antiplatelet therapy can effectively improve clopidogrel resistance in ACS patients after PCI.It can significantly reduce platelet aggregation activity,hemorrhage rate and recent MACE events,without increasing drug costs.Therefore,this scheme is recommended to be reasonable popularization and application in clinical practice.

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