血栓弹力图与透光率比浊法检测DES术后血小板高反应的研究  

Thrombelastogram and light transmittance aggregation test for detecting high platelet reactivity after DES implantation

作　　者：李伟[1,2] 宋现涛[1,2] 许锋[1,2] 吕树铮[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心内科一病房,北京100029

出　　处：《中国循证心血管医学杂志》2013年第6期604-607,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的观察血栓弹力图(TEG)与透光率比浊法(LTA)测定药物洗脱支架(DES)术后患者氯吡格雷治疗相关的血小板高反应性(HTPR)的结果对预后的影响。方法纳入择期DES术的患者264例,使用TEG检测二磷酸腺苷聚集幅度(MA-ADP),LTA检测二磷酸腺苷聚集(LTA-ADP)。随访6个月,记录主要心脑血管不良事件(包括心源性死亡、再梗死、缺血性卒中、非计划的再次血运重建和因冠状动脉缺血导致的再次住院等缺血事件及出血事件)。采用ROC曲线下面积(AUC)评估两种方法对血小板高反应的诊断价值,同时比较两种方法检测阳性者在随访期间发生不良事件有无差异。结果两种方法对HTPR的诊断价值存在差异(AUC MA-ADP=0.771vs.AUC LTA-ADP=0.603;Z=2.246,P<0.05);TEG的诊断界值为49.1 mm,以此为诊断标准发现阳性者不良事件发生率更高(19.5%vs.3.7%,P<0.05),LTA的诊断界值为44.5%,以此为诊断标准发现阳性者与阴性者不良事件发生率接近。结论 TEG测定HTPR的准确性较LTA更高,且TEG检测对判断预后的意义更大。Objective To observe the difference in the results of clopidogrel-related high platelet reactivity （HTPR） detected by thrombelastogram （TEG） or by light transmittance aggregation test （LTA） in the patients after drug eluting stent （DES） implantation and the influences of positive results of TEG or LTA on prognosis.Methods The patients （n=264） were chosen from Beijing Anzhen Hospital from Jan. 2011 to Oct. 2012. The level of MA-ADP was detected by using TEG and level of LTA-ADP was detected by using LTA. The patients were followed up for 6 months. The major adverse cardiovascular events （MACE, including sudden cardiac death, reinfarction, ischemia stroke, non-planed revascularization and rehospitalization because of coronary ischemia） were recorded. The diagnostic values of TEG and LTA to HTPR were reviewed by applying ROC area under the curve （AUC）. The difference in MACE was compared in the patients with positive results of TEG or LTA during follow-up period. Results The diagnostic values of TEG and LTA were different in the diagnosis of HTPR （AUCMA-ADP=0.771vs. AUCLTA-ADP=0.603,Z=2.246,P〈0.05）. The diagnostic critical value of TEG was 49.1 mm, and when taking which as diagnostic standard the incidence of MACE was higher in the patients with positive results of TEG （19.5%vs. 3.7%,P〈0.05）. The diagnostic critical value of LTA was 44.5%, and when taking which as diagnostic standard the incidence of MACE was similar in the patients with positive results of LTA and in those with negative results. Conclusion TEG is more accurate and significant than LTA in HTPR detection and prognosis prediction.

关 键 词：药物洗脱支架置入术 血小板功能检测 血栓弹力图 透光率比浊法 

分 类 号：R542.22[医药卫生—心血管疾病]