血栓弹力图评价冠状动脉介入治疗术后抗血小板药物疗效及与预后的关系  

Application of thrombelastography in evaluating effect of antiplatelet drugs for patients undergoing percutaneous coronary intervention and relationship with prognosis

作　　者：龚艳君[1] 邱林[1] 屈晨雪[2] 杨帆[1] 王智[1] 李建平[1] 刘兆平[1] 洪涛[1] 

机构地区：[1]北京大学第一医院心内科,北京100034 [2]北京大学第一医院检验科

出　　处：《中华全科医学》2016年第8期1289-1292,共4页Chinese Journal of General Practice

摘　　要：目的应用血栓弹力图(thrombelastography,TEG)分析冠状动脉介入治疗术后初始应用阿司匹林及氯吡格雷的患者血小板高反应性(high on-treatment platelet reactivity,HPR)的发生率及影响因素;分析HPR的发生与预后之间的关系。方法选取北京大学第一医院心内科2013年1月—2014年12月行冠状动脉介入治疗进行血栓弹力图血小板功能检测的冠心病患者335例。所有患者正进行阿司匹林及氯吡格雷双联抗血小板治疗。通过病案、门诊化验及门诊病历处方回顾,获得患者信息。应用血栓弹力图测定血小板抑制率,计算HPR的发生率,分析影响因素、随访临床事件及其发生时间等,分析HPR与预后的关系。采用SPSS 19.0统计软件进行数据分析,P<0.05为差异有统计学意义。结果患者阿司匹林治疗时HPR发生率为35.2%(118/335),氯吡格雷治疗时HPR发生率为34.6%(116/335)。部分临床情况对HPR的发生有所影响。完成随访308例,其中289例未调整抗血小板用药。阿司匹林治疗时HPR的发生与缺血事件存在一定联系(P=0.003),而氯吡格雷治疗时HPR与预后无明确相关性。结论 TEG检测的抗血小板药物HPR发生率较高,部分临床情况对其可能存在一定影响。阿司匹林治疗时HPR的存在与缺血事件发生有一定相关性。Objective To analyze the incidence and influencing factors of high on-treatment platelet reactivity（ HPR）using thrombelastography（ TEG） in patients undergoing percutaneous coronary intervention（ PCI） and dual anti-platelet therapy,and explore the relationship between the incidence of HPR and prognosis. Methods The data was collected from335 patients undergoing PCI and TEG examination in our hospital from January,2013 to December,2014. All patients were receiving dual anti-platelet therapy with Aspirin and clopidogrel. The medical records and prescription were reviewed. The platelet inhibition rate was examined with TEG and the rate of HPR was calculated,and the risk factors were analyzed. The follow-up for the clinical events was carried out to analyze the relationship between the occurrence of HPR and prognosis. SPSS 19. 0 statistical software was used for data analysis. Results The prevalence of HPR after treatment with aspirin was 35. 2%（ 118 /335）,with clopidogrel was 34. 6%（ 116 /335）. The occurrence of HPR was affected by some clinical conditions. 308 patients were followed up,and 289 of them did not change the anti-platelet drugs. HPR was correlated at some extent with the ischemic events in patients receiving aspirin treatment（ P = 0. 003）,nut not for clopidogrel treatment. Conclusion The incidence of HPR by TEG is prevalent in clinical practice,and some clinical conditions may affect HPR. HPR in patients receiving aspirin treatment is related with ischemic events.

关 键 词：冠心病 经皮冠状动脉介入治疗 血小板高反应性 血栓弹力图 

分 类 号：R541.4[医药卫生—心血管疾病]