TEG评价冠状动脉粥样硬化性心脏病患者PCI术后抗血小板治疗效果的临床研究  

Application of TEG in antiplatelet therapy after PCI in patients with atherosclerotic heart disease

作　　者：黎安玲[1] 陈薇[1] 胡汉宁[1] 吕民[1] 

机构地区：[1]武汉大学中南医院检验科,湖北武汉430071

出　　处：《中国现代医学杂志》2017年第1期94-98,共5页China Journal of Modern Medicine

摘　　要：目的评价采用血栓弹力图(TEG)观察经皮冠状动脉介入治疗(PCI)患者服用抗血小板药物后血小板抑制效果,以指导患者抗血小板聚集药物治疗的个性化调整。方法选择住院的98例冠状动脉粥样硬化性心脏病(CHD)PCI术后患者。其中,76例联合服用阿司匹林与氯吡格雷作为联合用药组,22例单独用药患者分别单独服用阿司匹林(阿司匹林组,12例)和氯吡格雷(氯吡格雷组,10例)。采用TEG检测花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率,分析两组血小板抑制率的差异。结果 TEG检测结果发现阿司匹林组AA途径诱导和氯吡格雷组ADP途径诱导的血小板抑制率分别为(66.35±20.13)%和(50.26±13.21)%,差异无统计学意义(P>0.05);与阿司匹林组AA途径和氯吡格雷组ADP途径诱导的血小板抑制率相比,联合用药组AA为(81.37±22.32)%,ADP为(57.66±24.32)%,差异无统计学意义(P>0.05)。结论阿司匹林与氯吡格雷均能起到很好的抗血小板作用,但氯吡格雷稍差,联合服用阿司匹林和氯吡格雷能起到更强的抗血小板作用。TEG检测能够有效识别患者对阿司匹林和/或氯吡格雷治疗的敏感性,从而采取针对性治疗措施。Objective To study the action of thrombelastogram （TEG） in evaluating the efficacy of antiplatelet therapy after percutaneous coronary intervention （PCI） in patients with coronary artery disease, so as to guide the individualized adjustment of anti-platelet aggregation drugs. Methods Ninety-eight patients with coronary heart disease were selected after PCI. Among the 98 patients, 76 patients were treated with Aspirin and Clopidogrel as the combination group and 12 patients were treated with Aspirin （Aspirin group） and 10 cases with Clopidogrel （Clopidogrel group）. TEG was used to detect inhibition rate of platelet aggregation induced by arachidonic acid （AA） and adenosine diphosphate （ADP） receptor pathways. The effect of antiplatelet therapy was compared among the groups. Results The AA-induced platelet inhibition rate in the Aspirin group was （61.35 ± 20.13）%, the ADP-induced platelet inhibition rate in the Clopidogrel group was （50.26 ± 13.21）%; there was no statistical difference （P〉 0.05）. In the combined medication group, the platelet inhibition rate induced by AA and ADP pathways was （81.37 ± 22.32）% and （57.66 ± 24.32）% respectively, which was higher than that of AA pathway in the Aspirin group and ADP pathway in the Clopidogrel group, but there were no significant differences （all P〉 0.05）. The effective rate of anti-platelet therapy in the combination therapy group was a little higher than that in the separate medication groups. Conclusions Both Aspirin and Clopidogrel can have good effect of anti-platelet aggregation, but the effect of Clopidogrel is slightly worse. Combined medication of Aspirin and Clopidogrel can play a more powerful role of anti-platelet aggregation. Thrombelastogram is an effective tool for assessing platelet inhibition rate. The clinicians might find the Aspirin and Clopidogrel-resistant patients according to AA- and ADP-induced platelet inhibition rates, and then modulate the therapeutic regimen.

关 键 词：血栓弹力图 血小板抑制率 阿司匹林 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]