TEG法与吸光度比浊法对ACS患者PCI术后CLR的诊断价值及临床分析  

The diagnostic value and clinical relevance of thrombelastography and light transmission aggregometry based identification of low response to clopidogrel in ACS patients after percutaneous coronary intervention

作　　者：赵磊[1] 徐双[1] 贾玫[1] 

机构地区：[1]北京大学人民医院检验科,100044

出　　处：《中华检验医学杂志》2016年第3期187-191,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨氯吡格雷低反应性（CLR）、临床相关因素与术后主要不良心血管事件（MACE）的关系。方法队列研究。选择2014年5至11月，于北京大学人民医院心内科住院拟行经皮冠状动脉介入治疗（PCI）治疗的急性冠状动脉综合征（ACS）患者214例。其中男168例（78．5％），年龄31～82（61．32±10．79）岁，女46例（21．5％），年龄46～80（68．72±8．38）岁，记录现病史、既往史、临床用药、冠状动脉造影结果等临床资料。所有患者给予氯吡格雷75mg／d治疗≥4d后，采用血栓弹力图（TEG）法检测ADP诱导血小板抑制率（TEG—ADP—Inhib）（％）和吸光度比浊（坍A）法检测ADP诱导最大血小板聚集率（LTA—ADPMAX）（％），统计CLR发生率，比较两种方法检测结果的相关性；按照是否诊断为CLR对患者分组，比较CLR组与非CLR组临床资料差异，将有显著差异变量进行Logistic回归，分析相关因素与发生CLR的关系；所有患者随访6个月，分析CLR与MACE的关系。结果LTA法与TEG法检测结果呈负相关（r=-0．282，P=0．000）。LTA法检出CLR115例（53．7％），TEG法检出CLR74例（34．6％），两法比较差异有统计学意义（χ^2=10．486，P=0．001）。按LTA法检测结果分组后，CLR组与非CLR组在年龄、吸烟史、PCI／CABG史差异有统计学意义（t=2．829，P=0．005；χ^2=11．058，P=0．001；χ^2=4．252，P=0．039）；按TEG法检测结果分组后，CLR组与非CLR组在脑血管意外病史差异有统计学意义（χ^2=4．584，P=0．032）。多因素Logistic回归分析结果显示吸烟（OR=0．390，P=0．001）是CLR的独立保护因素，脑血管意外病史（OR=2．499，P=0．037）是CLR的独立危险因素。PCI术后6个月内，LTA法和TEG法检出CLR患者MACE事件，差异均无统计学意义（χ^2=0．065，P=0．798；=0．432，P=0．511）。结论TEG法和LTA法检测ACS患者氯吡格雷反应性相关性较Objective To obtain the incidence of ＂clopidogrel low response＂（ CLR ） of acute coronary syndrome （ACS） patients after percutaneous coronary intervention （PCI） by Thrombelastography （TEG） and Light transmission aggregometry（ LTA）, and explore the correlation of CLR with clinical related factors and major adverse cardiac events. Methods This study is a cohort study. 214 ACS patients in the Department of Cardiology of Peking University People＇s Hospital, who were ready to treat with PCI between May 2014 and November 2014 were enrolled. Among them, 168 cases（78.5% ） were male with an average age of （61.32 ±10. 79） years;46 cases（21.5% ） were female with an average age of （68. 72 ±8.38） years. The clinical data were recorded, such as history of present illness, the past medical history, clinical medication, and the results of coronary angiography. After taken clopidogrel 75 mg per day at least for 4 days, all patients were detected the contribution from ADP-stimulated platelets to maximal clot strength by TEG（TEG-ADP-Inhib）, and detected ADP induced maximal platclet aggregation ratio by LTA （LTA- ADPMAX ）. The occurrence rate of CLR was calculated, and the correlation between results of the two assays were anylysed. Patients were divided into two groups according to CLR. Univariate analysis was used to compare the difference of clinical data between CLR group and non-CLR group, then Logistic regression analysis was conducted to find out the related risk factors that may imqnence the occurrence rate of CLR. Compare the correlation between CLR and MACE according to 6-month followed-up. Results There was negative correlations between LAT and TEG in the adenosine diphosphate induced platelet reactivity （ r = - 0. 282 ,P =0. 000）. CLR was found in 115 （53.7%） patients by LTA and in 74（34. 6% ） patients by TEG and the difference between the two CLR ratio was significant （ χ^2= 10. 486, P = 0. 001 ） . There were significant differences in age, smoking hist

关 键 词：血栓弹力描记术 光密度测定法 噻氯匹定 急性冠脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]