Sonoclot凝血分析法评价冠心病血小板氯吡格雷反应性研究  

Evaluation of platelet reactivity in coronary heart disease patients on clopidogrel treatment by sonoclot coagulation and platelet function analyzer.

作　　者：孙海英[1,2] 周欣[2] 卢芮伊[2] 杨国红[2] 郭兆增 石 蕊[2] 曾山[2] 姬文婕[3] 姜铁民[2] 李玉明[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]武警后勤学院附属医院心血管病研究所心脏中心,天津300162 [3]武警后勤学院附属医院呼吸与重症医学科,天津300162

出　　处：《中国实用内科杂志》2014年第1期50-53,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81070121;81170238);天津市自然科学基金(09ZCZDSF04200;11JCYBJC12000)

摘　　要：目的探讨Sonoclot凝血分析法评价冠心病患者氯吡格雷反应性的有效性。方法选取2012年武警后勤学院附属医院心脏中心收治的82例冠心病患者,分别用Sonoclot凝血分析法和舒血管刺激磷蛋白(VASP)法检测血小板反应性。以血小板VASP测定的血小板反应指数≥50%为氯吡格雷低反应性的标准,探讨Sonoclot凝血分析法与血小板VASP磷酸化法的相关性。结果 Sonoclot凝血分析法中ADP和NON通路中凝血速率差值与凝血酶原时间呈正相关(r=0.22,P<0.05);血小板功能的差值与血小板VASP磷酸化呈正相关(r=0.38,P<0.01);受试者工作特征曲线分析,Sonoclot凝血分析法判定氯吡格雷反应性的曲线下面积为0.67(P<0.01),敏感度为72.34%,特异度为57.14%。结论 Sonoclot凝血分析法与血小板VASP磷酸化法之间存在相关性,可以用于氯吡格雷反应性的评价。Objective To evaluate the effectiveness of Sonoclot analysis detected clopidogrel responsiveness in patients with coronary heart disease （CHD）. Methods A total of 82 CHD patients with unstable angina were enrolled. Platelet reactivity was determined by two methods：Sonoclot analysis and Flow cytometry determined phosphorylation of vasodilator-stimulated phosphoprotein （VASP） in platelets. High on-treatment platelet reactivity was defined when VASP analysis derived platelet reactivity index 950%. Results The difference of coagulation rate between ADP- and NON-channel was positively corre- lated with prothrombin time （ r = 0. 22, P 〈 0. 05 ）. Platelet reactivity index was positively correlated with the difference of PF in two channels （r =0. 38, P 〈 0. 01 ）. The receiver operating characteristic （ROC） curve analysis showed that the dis- criminative value of Sonoclot analysis for clopidogrel responsiveness had an area under curve value of 0. 67 （ P 〈 0. 01 ） with a sensitivity and specificity of 72. 34% and 57.14% , respectively. Conclusion There is an association between Sonoelot analysis and platelet VASP phosphorylation and Sonoclot analysis may be used to evaluate clopidogrel responsiveness in pa tients with CHD.

关 键 词：冠心病 凝血功能 血小板反应性 流式细胞术 

分 类 号：R435[医药卫生—临床医学]