中文摘要：

目的探讨低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL—C）对急性冠脉综合征（acute coronary syndrome，ACS）患者氯吡格雷抗血小板反应性的影响。方法根据入选和排除标准，在2011年9月-2012年9月，前瞻性连续募集住院期间行氯吡格雷抗血小板治疗的ACS患者，检测患者服用稳定剂量氯吡格雷后第五天的腺苷二磷酸（ADP）诱导的血小板聚集率。根据LDL—C水平将患者分为正常组（LDL—C〈1．8mmol／L）和异常组（LDL—C≥1．8mmol／L），观察不同水平LDL—C对氟吡格雷治疗后血小板聚集率的影响。利用单因素相关和多元线性回归统计方法，分析患者一般情况和临床特征与血小板聚集率的相关性。结果在连续募集的500例符合入选标准的经氯吡格雷抗血小板治疗的ACS患者中，LDL—C异常组患者的血小板聚集率显著高于LDL—C正常组患者[（42．27±19．07）vs．（38．18±18．13）％，P=0．04]。单因素相关分析发现，LDL—C水平与血小板聚集率具有显著的相关性（r=0．113，P=0．01）。多元线性回归分析发现，经校对性别、β受体阻滞剂、质子泵抑制剂、替罗非班等影响因素后，LDL—C仍与血小板聚集率显著相关（P=0．01）。结论LDL—C水平可影响ACS患者氯吡格雷抗血小板治疗的反应性。

英文摘要：

Objective To investigate the effect of low density lipoprotein cholesterol on platelet reactivity of acute coronary syndrome （ACS） patients treated with clopidogrel. Methods Consecutive ACS patients admitted to the institute of geriatric cardiology of Chinese PLA hospital from September 2011 to September 2012 were recruited according to inclusion criteria and exclusion criteria. ADP- induced platelet aggregation was tested after 5 days maintenance dose of clopidogrel administration. Patients were divided into two groups according to LDL- C level： high LDL- C group （LDL- C≥1.8mmol/L） and normal LDL- C group （LDL- C〈1.8mmol/L）. Clopidogrel on- treatment platelet aggregation was compared between the groups categorized by LDL- C levels. The association between LDL- C level and platelet aggregation was analyzed by univariate analysis and multi linear regression analysis. Results A total of 500 consecutive ACS patients treated with clopidogrel were recruited according to the inclusion criteria. Clopidogrel on- treatment platelet aggregation in high LDL- C group was significantly higher than that in normal LDL- C group [（42.27 ± 19.07） vs. （38.18 ±18.13）%, P= 0.04]. LDL-C level was associated with platelet aggregation by univariate analysis （P = 0.01）. Multi linear regression showed a significant association between LDL- C level and platelet aggregation after adjustment for gender, ;receptor blocker, proton pump inhibitors and tirofiban （P = 0.01）. Conclusion LDL-C level can influence clopidogrel anti- platelet responsiveness in ACS patients.