血小板功能试验监测P2Y_(12)受体拮抗剂的抗血小板聚集效果研究进展  

Research progress of platelet function tests in antiplatelet effect on monitoring P2Y_(12) receptor antagonist

作　　者：孔繁强[1] 任静[1] 门剑龙[1] KONG Fan-qiang;REN Jing;MEN Jian-long(Medical Laboratory, Tianjin Medical University General Hospital, Tianjin 300052, China)

机构地区：[1]天津医科大学总医院医学检验科,300052

出　　处：《天津医药》2017年第6期663-667,共5页Tianjin Medical Journal

基　　金：天津市科技计划项目(16KPXMSF00170)

摘　　要：P2Y_(12)受体拮抗剂广泛应用于心脑血管疾病的预防和治疗中,而监测治疗后血小板功能变化有助于改善患者的预后。血小板功能试验是评估抗血小板聚集治疗后残留血小板高反应性的重要方法,主要包括透射光法血小板聚集试验(LTA)、电阻抗法血小板聚集试验(WBIA)、血管舒张剂刺激磷酸蛋白(VASP)、血栓弹力图(TEG)、血小板功能分析仪-100型(PFA-100)和Verify Now系统。这些试验监测抗血小板聚集治疗后血小板残留反应性的能力各不相同,评估效果也各有不同。其中,LTA是评估抗血小板药物疗效的经典方法,便捷而廉价,但易受操作和环境干扰;WBIA临床应用较少,缺乏评估临界值;VASP对血小板功能变化敏感,但试验复杂且成本高;TEG能监测药物对血小板的抑制率,但指导治疗的安全性还需要验证;PFA-100监测抗血小板聚集药物的敏感性和特异性尚不明确;Verify Now有效可靠,但成本过高。临床研究证据显示,LTA、VASP和Verify Now系统能敏感反映P2Y_(12)受体拮抗剂抗血小板聚集的效果,且与心血管疾病患者主要不良心脏事件(MACE)风险相关。The P2Y12receptor antagonist is used widely in prevention and treatment of cardiovascular andcerebrovascular disease.Monitoring changes of platelet function after treatment can improve the prognosis of patients.Theplatelet function test is the important way to evaluate high residual platelet reactivity after antiplatelet treatment,includinglight transmission aggregometry(LTA),whole blood impedance aggregometry assay(WBIA),vasodilator-stimulatedphosphoprotein(VASP),thrombelastogram(TEG),platelet function analyzer-100(PFA-100)and VerifyNow system(VerifyNow).It is very different for the reflecting ability with residual reactivity of platelets among these tests after antiplatelettherapy,and also significant difference for assessment effect.Among them,LTA is a classic method for the curativeeffect evaluation of anti-platelet agents,which is convenient and cheap,but it is susceptible to the operating andenvironment interference.The clinical application of WBIA is less,and which lacks threshold value for assessment.VASP issensitive for the changes of platelet function,but the test is complex and expensive.TEG can monitor the inhibition ratio ofdrugs on anti-platelets,but it needs to verify the safety of treatment.It is not clear for sensitivity and specificity withmonitoring anti-platelet agent by PFA-100.VerifyNow is effective and reliable,but the cost is high.The evidence of clinicalstudy shows that LTA,VASP and VerifyNow can reflect the effect of platelet inhibition of P2Y12receptor antagonistssensitively,and is associated with the risk of major adverse cardiac events(MACE)in patients with cadiovascular diseases.

关 键 词：预后 综述 P2Y12 受体拮抗剂 血小板功能试验 实验室临界值 

分 类 号：R446.114.5[医药卫生—诊断学]