血栓弹力图检测在急性冠状动脉综合征患者中的临床应用价值  

Clinical usefulness of thrombelastograph in patients with acute coronary syndrome

作　　者：吴鸿谊[1] 钱菊英[1] 王齐兵[1] 孙爱军[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所,上海200032

出　　处：《上海医学》2013年第9期752-756,共5页Shanghai Medical Journal

摘　　要：目的在植入药物支架后的急性冠状动脉综合征（ACS）患者中，评价血栓弹力图（TEG）检测的抗血小板药物反应性与近期临床预后的关系。方法447例ACS患者行前瞻性研究，所有患者均接受冠状动脉造影检查并植入药物支架，在口服双联抗血小板药物负荷量24h后，采用TEG检测患者的血小板功能。若二磷酸腺苷（ADP）诱导的血小板抑制率〈30％，则认为氯吡格雷反应低下；若花生四烯酸（AA）诱导的血小板抑制率〈50％，则认为阿司匹林反应低下。临床随访1个月观察有无缺血性事件（心源性死亡、非致死性心肌梗死和缺血性脑卒中）发生。结果氯吡格雷负荷后，ADP诱导的平均血小板聚集率为（45．8±24．8）％，资料呈正态分布，其中82例（18．3％）患者对氯吡格雷反应低下。阿司匹林负荷后，AA诱导的平均血小板聚集率为（20．1±19．6）％，患者对阿司匹林的反应呈现反应良好的群集现象，其中43例（9．6％）患者对阿司匹林反应低下。447例患者1个月中有13例（2．9％）发生了缺血性事件，据此分为事件组和无事件组。事件组对氯吡格雷反应低下患者的构成比（7／13）显著高于无事件组（17．3％，P=0．004），ADP诱导的平均血小板抑制率（35．7％±23．3％）显著低于无事件组（54．7％±24．6％，P=0．006），残留高血小板活性的构成比（8／13）显著高于无事件组（21．9％，P=0．001）。事件组与无事件组间患者对阿司匹林的反应性的差异均无统计学意义（P值均〉O．05）。氯吡格雷反应低下（OR=5．031，95％CI为1．566～16．155，P=0．007）和糖尿病（OR=3．930，95％CI为1．206～12．802，P=0．023）是预测近期缺血性事件的独立危险因素。结论通过TEG检测ACS患者的血小板功能有助于发现患者对氯吡格雷反应的差异，氯吡格雷反应低下的患者近期发生缺血性事�Objective To evaluate the relationship between short-term clinical outcome and platelet function assessed by thrombelastograph （TEG） in patients with acute coronary syndrome （ACS） after drug-eluting stent （DESI） implantation. Methods A total of 447 AOS patients were enrolled in this prospective study. They underwent coronary arteriongraphy and DES implantation. Platelet function was detected by TEG 24 h after dual anti-platelet treatment. Clopidogrel low-responsiveness was defined as less than 30% adenosine diphosphate （ADP）-induced platelet inhibition. Aspirin low-responsiveness was defined as less than 50% arachidonic acid （AA）-induced platelet inhibition. Ischemic events, such as cardiac death, nonfatal myocardial infarction, and cerebral arterial thrombosis, were observed during a one-month follow-up. Results After clopidogrel loading, platelet aggregation was （45.8 ±. 24.8） % and was depicted by normal distribution; 82 patients （ 18.3% ） were categorized as clopidogrel low-responsiveness. However, only 43 patients （9.6%） were categorized as aspirin low-responsiveness; platelet aggregation was （20. 1 ±19.6）%. Ischemic events occurred within 1 month in 13 patients （2.9 % ）. On-clopidogrel platelet inhibition was significantly lower in patients with ischemic events than in those without ischemic events （35. 7% ±23. 3% vs. 54. 7% ±24. 6%, P = 0. 006）. High residual plateletreactivity （MAADP〉47 mm） was more frequently observed in patients with ischemia than those without ischemia （61.5% vs. 21.9%, P=0. 001）. There was no significant difference in aspirin responsiveness between the patients with and without ischemic events （P〉0.05）. Clopidogrel low-responsiveness （ OR = 5. 031, 95% CI ： 1. 566- 16. 155, P = 0. 007） and diabetes mellitus （OR = 3. 930, 95% Cl.. 1. 206 - 12. 802, P = 0. 023） were independent risk factors for predicting short-term ischemic event. Conclusion TEG may be a useful tool to assess antiplatelet therapy. Low response to

关 键 词：急性冠状动脉综合征 血小板 氯吡格雷 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]