血栓弹力图在冠心病介入术后氯吡格雷低反应性研究  

Using thrombelastography test to assess low response to clopidogrel in coronary heart disease patients after percutaneous coronary intervention

作　　者：赵燕[1] 杨明[1] 金新[1] 崔建英[1] 孙一光[1] 马杰[1] 陈立伟[1] 高亢[1] 李晓红[1] 

机构地区：[1]首都医科大学附属复兴医院心内科,北京100038

出　　处：《临床内科杂志》2014年第5期334-337,共4页Journal of Clinical Internal Medicine

基　　金：首都医学发展科研基金项目（2009-3191）

摘　　要：目的 应用血栓弹力图（TEG）监测冠心病患者双联抗血小板治疗效果,主要观察氯吡格雷对二磷酸腺苷（ADP）诱导的血小板抑制率,同时观察患者临床缺血及出血事件的发生情况.在应用TEG监测同时,用流式细胞术监测患者抗血小板效果,探讨更适用临床的检测模式.方法 同时应用TEG及流式细胞仪分别检测血小板活化标志物CD62p和PAC-1,观察临床终点事件的发生.结果 TEG中ADP抑制率与血小板-纤维蛋白凝块强度（MAADP）检测血小板功能,有较好的敏感性和特异性,ADP抑制率为32.70％时受试者工作特征曲线（ROC曲线）下的面积最大0.715（95％ CI：0.609 ～0.822,P=0.001）,MAADP为42.05 mm时ROC曲线下的面积最大0.869（95％ CI：0.794 ～0.944,P=0.000）,MAADP较ADP能更准确地反映患者抗血小板效果.结论 TEG检测的ADP抑制率在＜32.70％与MAADP＞ 42.05 mm时可能反映患者对氯吡格雷反应性低下,具有较好的缺血事件预测价值.Objective To assess the anti-platelet therapy responsivity in coronary heart disease using thrombelastography （TEG） test and observe its impact on patients clinical prognosis,the main observation on the ADP inhibition rate to clopidogrel.Also to observe platelet activation marker P-selectin （CD62p）,platelet membrane glycoprotein Ⅱ b/ Ⅲ a（PAC-1）.Methods Using different method to observe anti-platelet therapy responsivity and its impact on patients clinical prognosis at the same time.Results By flow cytometry as the reference standard,the the ADP inhibition rate and MAADP respectively 32.70% and 42.05 mm has a high sensitivity and specificity（70.0%,62.0% and 81.0%,81.0%）,respectively.MAADP of assessment platelet function has a better sensitivity to reflect anti-platelet therapy responsivity.Conclusion Using Thrombelastography （TEG） test,ADP inhibition rate 〈 32.70% and MAADP 〉42.05 mm may reflect the low response to clopidogrel and have a better ischemic predictive value.

关 键 词：血栓弹力图 二磷酸腺苷诱导的血小板抑制率 血小板-纤维蛋白凝块强度 血小板活化标志物CD62p PAC-1 

分 类 号：R541.4[医药卫生—心血管疾病]