关键词: 冠心病, 二级预防, 多重用药, 氯吡格雷抵抗, 影响因素分析

Abstract: Background　Polypharmacy is a major factor that can lead to potentially dangerous drug interactions.Patients with coronary heart disease（CHD） often face problems of polypharmacy.Clopidogrel，a basic drug for secondary prevention of CHD，its antiaggregating activity is easily influenced by drug interactions.However，the influence of polypharmacy on the effect of clopidogrel has been rarely reported.Objective　To analyze the factors associated with clopidogrel resistance（CR） in patients with CHD treated with polypharmacy.Methods　According to the inclusion and exclusion criteria，333 cases of CHD were enrolled from Wuxi People's Hospital，Nanjing Medical University，from September 2015 to March 2018.Through the information system of the hospital，basic information（including sex，age，prevalence of smoking，prevalence of drinking，comorbidity，clinical diagnosis，NYHA functional classification，PCI treatment），physical examination and laboratory results〔including body mass index（BMI），blood pressure，total cholesterol，low-density lipoprotein cholesterol（LDL-C），fasting blood glucose（FBG），serum creatinine，alanine aminotransferase and platelet aggregation rate（PAR）〕，and medication〔including proton pump inhibitors （PPI），diltiazem， statins （atorvastatin and simvastatin）， calcium channel antagonists （CCB），ARB，metoprolol，nitrates，trimetazidine，traditional Chinese medicine containing anti-thrombotic ingredients，low molecular weight heparin〕 were collected.On the basis of the PAR level，132 cases were assigned to the CR group（PAR>50%），and 201 were assigned to the control group（PAR≤50%），respectively.Factors associated with CR were identified by multivariate Logistic regression analyses.Results　The incidence of hypertension，rates of BMI≥25.0 kg/m2，LDL-C≥2.07 mmol/L，FBG，and polypharmacy（≥7）were significantly higher in CR group than those of the control group（P<0.05）．Multivariate Logistic regression analysis showed that FBG（≥6.1 mmol/L）（OR=1.121，P=0.033） and concomitant medications（≥7）（OR=5.224，P=0.003） were associated factors for CR．The combined use rates of traditional Chinese medicine injection containing antithrombotic components and low molecular weight heparin were also obviously higher in the CR group（P<0.05）．Conclusion　FBG and polypharmacy（≥7） are associated with CR.Moreover，combined use of low molecular weight heparin and traditional Chinese medicine injections containing antithrombotic ingredients may also be related to CR.

Key words: Coronary disease, Secondary prevention, Polypharmacy, Clopidogrel resistance, Root cause analysis