经皮冠状动脉介入术后血小板高反应性的影响因素及预后评价  

Influential factors and prognostic evaluation of high post-treatment platelet reactivity in patients undergoing percutaneous coronary intervention

作　　者：房晓楠[1] 鲁洁[1] 郑欣馨[1] 郭颖[1] 宋昌鹏 黄晓红[1] FANG Xiao-nan, LU die, ZHENG Xin-xin, GUO Ying, SONG Chang-peng, HUANG Xiao-hong.(Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037. China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院特需中心18病区,北京市100037

出　　处：《中国分子心脏病学杂志》2018年第4期2535-2538,共4页Molecular Cardiology of China

基　　金：中央保健课题(2014-ZYB01)

摘　　要：目的了解经皮冠状动脉介入术(percutaneous coronary intervention,PCI)双重抗血小板治疗后,血小板高反应性实际发生情况,相关临床影响因素,及对缺血事件的预测价值。方法选取2012年1月至2012年12月收住阜外医院特需病房(18病区)接受PCI治疗的冠心病患者341例,围手术期及术后规律口服拜阿司匹林、氯吡格雷抗血小板治疗,术后使用血栓弹力图(thrombelastography,TEG)测定血小板反应性,将二磷酸腺苷(ADP)诱导的凝血块最大强度(MA_(ADP))>47mm且ADP诱导的血小板抑制率(ADP%)<50%的患者纳入氯吡格雷治疗后血小板高反应性(high post-treatment platelet reactivity,HPPR)组,其他患者纳入血小板反应正常(Normal Platelet Reactivity,NPR)组,比较两组基础临床资料、冠脉病变范围、支架数量、实验室指标,并采用Logistic回归分析影响HPPR的因素。进行三年随访,比较两组主要不良心脏事件(major adverse cardiac events,MACE)发生情况的差异。结果 341例患者HPPR的发生率达25.8%,在HPPR单因素分析中,性别、年龄、吸烟、D-二聚体(D-dimer)、纤维蛋白原(Fbg)、高敏C反应蛋白(HsCRP)有统计学差异(P<0.05);以上因素经条件Logistic回归分析示年龄(OR=0.976,95%CI:0.952～1,P<0.05)、性别(OR=2.815,95%CI:1.339～5.916,P<0.05)、Fbg(OR=0.553 95%CI:0.375-0.816,P<0.05)为HPPR独立影响因素;两组在MACE事件发生率上无统计学差异(P>0.05)。结论高龄、女性、Fbg升高为HPPR的独立危险因素,HPPR与缺血事件发生无明显关系。Objective To investigate the incidence and influential factors of high post-treatment platelet reactivity （HPPR） in patients undergoing dual antiplatelet therapy after percutaneous coronary intervention （PCI）. To evaluate prognostic impact of HPPR for ischemic events. Methods There were 341 patients with coronary heart disease （CHD） receiving PCI in the ward 18 of our hospital. All patients had been given enough dose of aspirin and clopidogrel. Thrombelastograph （TEG） was used to measure platelet reactivity. Defining the platelet inhibition rate induced by adenosine diphosphate （ADP）〈50% and ADP-induced maximal clot （MAADp）〉 47 mm as HPPR group,the rest patients were divided to normal platelet reactivity （NPR） group. The baseline data, range of coronary artery disease, number of stent, laboratory examination results were compared between HPPR and NPR group .Logistic regression was applied to analyze the influential factors of HPPR as well.Three-year follow-up was conducted to compare the differences in major adverse cardiac events （MACE） between the two groups. Results The incidence of HPPR in 341 patients after PCI was 25.8% .In univariate analysis of HPPR ,there were statistically significant differences in age, gende,smoking, D-dimer, fibrinogen （Fbg） and high-sensitivity C-reactive protein （HsCRP） between HPPR and NPR groups （P 〈 0.05）.A conditional logistic regression analysis showed that the age （OR = 0.976,95% CI： 0.952-1, P 〈0.05）, gender （OR = 2.815,95% CI： 1.339-5.916, P 〈0.05）, Fbg （OR= 0.553,95% CI： 0.375-0.816, P 〈0.05） were independently influencing factors of HPPR. There was no significant difference in the incidence of MACE between the two groups （P〉 0.05）. Conclusion The elderly, females and high level of Fbg are probably independent risk factors of HPPR. There is no significant correlation between HPPR and ischemic events.

关 键 词：血小板高反应性 血栓弹力图 经皮冠状动脉介入术 

分 类 号：R541.4[医药卫生—心血管疾病]