TEG在评价冠心病患者PCI术后抗血小板治疗效果及监测缺血、出血事件发生中的作用  

The role of TEG in evaluating the effect of antiplatelet therapy in patients with coronary heart disease after PCI and monitoring the occurrence of ischemia and hemorrhage events

作　　者：杜玉斌[1] 李丹[1] 黄思兵[1] 张法宁 DU Yubin;LI Dan;HUANG Sibing;ZHANG Faning(Department of Cardiovascular Medicine, Huizhou First People′s Hospital, Guangdong Province, Huizhou 516003, China)

机构地区：[1]广东省惠州市第一人民医院心血管内科,广东惠州516003

出　　处：《中国医药导报》2019年第11期50-53,共4页China Medical Herald

基　　金：广东省惠州市科技计划项目(20170401)

摘　　要：目的应用血栓弹力图(TEG)监测冠心病患者经皮冠状动脉介入(PCI)术后应用抗血小板药物的效果,分析其与PCI术后患者缺血和出血事件的关系。方法收集2017年7月～2018年5月广东省惠州市第一人民医院(以下简称"我院")诊断为冠心病并行PCI治疗的患者300例,均予阿司匹林和氯吡格雷进行双联抗血小板治疗,以血小板花生四烯酸(AA)途径血小板聚集抑制率≥50%定义阿司匹林起效,二磷酸腺苷(ADP)途径血小板聚集抑制率≥30%定义氯吡格雷起效。根据TEG AA/ADP抑制率结果分为阿司匹林+氯吡格雷起效组(AA及ADP抑制率均达标)200例,阿司匹林未起效组30例,氯吡格雷未起效组50例,阿司匹林+氯吡格雷未起效组20例。比较四组的血小板抑制率及随访半年内的缺血事件总发生率。根据TEG中二磷酸腺苷诱导最大血块强度(MA-ADP)结果分为MA-ADP<31 mm组、31 mm≤MA-ADP≤47 mm组、MA-ADP>47 mm组,比较三组的血小板抑制率、出血事件总发生率。结果四组患者的血小板抑制率、缺血事件总发生率比较,差异有统计学意义(P <0.05)。阿司匹林+氯吡格雷起效组血小板抑制率最高,显著高于其他各组(P <0.05)。阿司匹林+氯吡格雷未起效组的缺血事件总发生率达35.00%,显著高于其他各组(P <0.05)。将纳入的300例患者按照TEG MA-ADP结果分为MA-ADP<31 mm组、31 mm≤MA-ADP≤47 mm组、MA-ADP>47 mm组,三组患者血小板抑制率、出血事件总发生率比较,差异有统计学意义(P <0.05)。其中MA-ADP>47 mm组的血小板抑制率显著低于其他两组(P <0.05)。其中MA-ADP>47 mm组的出血事件总发生率仅5%,显著低于其他两组(P <0.05)。结论对于PCI术后接受抗血小板治疗的患者,应用TEG进行监测,可指导抗血小板治疗方案的调整,确保血小板聚集活性的抑制效果,从而减少心血管不良事件的发生。Objective To monitor the effect of antiplatelet drugs after percutaneous coronary intervention (PCI) in patients with coronary heart disease by thromboelastography (TEG), and to analyze its relationship with ischemic and hemorrhagic events after PCI. Methods A total of 300 patients with coronary heart disease diagnosed by the First People′s Hospital of Huizhou City of Guangdong Province ("our hospital" for short) and treated with PCI were collected from July 2017 to May 2018. All patients were treated with aspirin and clopidogrel for antiplatelet therapy. The arachidonic acid (AA) pathway platelet aggregation inhibition rate ≥ 50% defines Aspirin onset;the adenosine diphosphate (ADP) pathway platelet aggregation inhibition rate ≥ 30% defines Clopidogrel onset. According to the results of TEG AA/ADP inhibition rate, 200 cases were divided into Aspirin + Clopidogrel effective group (AA and ADP inhibition rates were up to standard), 30 cases in Aspirin ineffective group, 50 cases in Clopidogrel ineffective group and 20 cases in Aspirin + Clopidogrel ineffective group. The platelet inhibition rate and the total incidence of ischemic events within half a year were compared among the four groups. According to the results of the maximum clot intensification (MA-ADP) induced by adenosine diphosphate in TEG, the patients were divided into MA-ADP<31 mm group, 31 mm≤MA-ADP≤47 mm group and MA-ADP>47 mm group. The platelet inhibition rate and the total incidence of bleeding events were compared among the three groups. Results The platelet inhibition rate and the total incidence of ischemic events in the four groups were significantly different (P < 0.05). The platelet inhibition rate of aspirin + clopidogrel group was the highest, which was significantly higher than that of other groups (P < 0.05). The total incidence of ischemic events in aspirin + clopidogrel group was 35.00%, which was significantly higher than that in other groups (P < 0.05). The 300 patients were divided into MA-ADP < 31 mm group, 31 mm < MA-AD

关 键 词：血栓弹力图 冠心病 经皮冠状动脉介入治疗 阿司匹林 氯吡格雷 

分 类 号：R541.4[医药卫生—心血管疾病]