中文摘要：

目的 探讨替格瑞洛治疗氯吡格雷抵抗的急性冠脉综合征（ACS）患者的疗效.方法 入选我院2012年6月至2015年2月初次诊断为ACS的患者559例,筛选出氯吡格雷抵抗患者105例,随机分为替格瑞洛组（53例）和氯吡格雷组（52例）.记录入选患者的一般资料,包括年龄、性别、高血压、糖尿病、高脂血症、吸烟史、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）等,测定所有患者服用药物5d前、后最大血小板聚集率,随访30 d内两组全因死亡、支架内血栓形成、再发非致命性心肌梗死、出血、呼吸困难发生率.结果 替格瑞洛组和氯吡格雷组在年龄,性别构成,合并高血压、糖尿病、高脂血症方面比较未见统计学差异（P＞0.05）;两组PFG、TC、TG、HDL-C、LDL-C比较未见统计学差异（P＞0.05）.替格瑞洛组MPA下降率、MPA达标率优于氯吡格雷组[（16.2±7.4）％比（4.1±1.9）％,P=0.000;88.7％比19.2％,P=0.000];替格瑞洛组全因死亡率、支架内血栓形成、再发非致命性心肌梗死更低（5.66％比21.15％,P=0.020;3.77％比44.23％,P=-0.000;7.55％比23.08％,P=0.007）;两组出血、呼吸困难发生率比较未见统计学差异（13.2％比11.5％,P=0.795,x^2=0.067;3.77％比5.77％,P=0.678,x^2=0.230）.结论 对氯吡格雷抵抗的ACS患者,替格瑞洛临床疗效优于氯吡格雷,安全性二者相当.

英文摘要：

Objective To explore the efficacy of Ticagrelor in acute coronary syndrome （ACS） patients with Clopidogrel resistance. Methods 559 patients were diagnosed ACS June 2012 to Feb 2015 in our hospital. Patients diagnosed of Clopidogrel resistance were randomly divided into Ticagrelor group （53 cases） or Clopidogrel group（52 cases ）. 105 patients were studied basic clinical characteristic, fasting blood glucose（PFG）, total choles- terol（TC ）, triglycerides （TG）, high density lipoprotein cholesterol（ HDL-C ） and low density lipoprotein cholesterol （LDL-C） were determined in all the patients. Determination maximum platelet aggregation rate in patients taking clopidogrel before and after five days, following of two groups within 30 d, recording the incidence of all-cause mortality, stent thrombosis, recurrence of non-fatal myocardial infarction, bleeding, breathing difficulties. Results Compared with Clopidogrel group, there were no statistical significance （P〉0.05） in age, sex, hypertension, dia- betes, hyperlipidemia, in two groups of patients, PFG, TC, TG, HDL, LDL-C were no statistical significance （P〉0.05）. Ticagrelor group is superior to Clopidogrel group in MPA drop rate, MPA success rate [（16.2±7.4）% vs.（4.1±1.9）%, P=0.000, 88.7% vs. 19.2%,P=0.000]. Ticagrelor group is lower in all-cause mortality, stent thrombosis, recurrence non-fatal myocardial infarction （5.66% vs. 21.15%, P=0.020, 3.77% vs. 44.23%, P=0.000, 7.55% vs. 23.08%, P=0.007）. Two groups have no statistical significance in the incidence of hemorrhage, difficulty breathing（ 13.2% vs. 11.5%, P=0.795, x^2=0.067, 3.77% vs. 5.77%, P=0.678, x^2=0.230）. Conclusion This study preliminarily confirmed in ACS patients with Clopidogrel resistance, Tieagrelor is better than that of Clopidogrel in curative effect and the security is both quite.