光学比浊法与血栓弹力图评价阿司匹林疗效的一致性研究及阿司匹林抵抗风险因素分析  

Study on the consistency of thromboelastography and light transmission aggregometry in monitoring aspirin efficacy and the risk factors of aspirin resistance

作　　者：孙越红[1,2] 张丽敏 许惠文[1,2] 李虓 王丹 王平[1,2] 赵晖 张国军[1,2] SUN Yuehong;ZHANG Limin;XU Huiwen;LI Xiao;WANG Dan;WANG Ping;ZHAO Hui;ZHANG Guojun(Department of Clinical Laboratory,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China;Beijing Engineering Research Center of Immunological Reagents Clinical Research,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院检验科,北京100070 [2]北京市免疫试剂临床工程技术研究中心,北京100070

出　　处：《国际检验医学杂志》2020年第19期2351-2354,共4页International Journal of Laboratory Medicine

基　　金：北京天坛医院院青年科学基金项目(2016-YQN-09);首都医科大学科研培育基金项目(PYZ2017067)。

摘　　要：目的以血栓弹力图法(TEG)为比对方法,研究光学比浊法(LTA)检测血小板聚集率在阿司匹林疗效评价方面的作用,观察二者是否具有良好的一致性,并根据LTA检测结果,对影响阿司匹林疗效的可能风险因素进行评估。方法选择2018年11月至2019年10月于首都医科大学附属北京天坛医院就诊的患者240例,均给予双联抗血小板药物治疗,其中有165例同时进行了TEG和LTA检测,采用Kappa值(κ)评价两种检测方法的一致性,并对相关参数进行相关分析。240例患者中有146例诊断为急性缺血性脑卒中,根据LTA检测结果将这部分患者划分为阿司匹林抵抗组和阿司匹林非抵抗组,比较两组患者的临床资料及实验室指标,并采用Logistic回归分析阿司匹林抵抗可能的风险因素。结果LTA及TEG在评价血小板功能方面具有良好的一致性(κ=0.543,P=0.000),且LTA检测的由花生四烯酸(AA)诱导的血小板最大聚集率(PAg-AA%)与TEG检测的血小板聚集抑制率(AA%)呈负相关(r=-0.557,P=0.000)。与阿司匹林非抵抗组比较,阿司匹林抵抗患者D-二聚体水平较高,平均血小板体积(MPV)较大,差异有统计学意义(P<0.05)。多元Logistic回归分析显示D-二聚体(OR=4.436,95%CI:1.810~10.868,P=0.001)和MPV(OR=2.687,95%CI:1.038~6.954,P=0.042)构成阿司匹林抵抗的独立风险因素。结论LTA可作为早期评价阿司匹林疗效的有效可靠的检测方法。高水平的D-二聚体及MPV构成阿司匹林抵抗的独立风险因素。Objective To study the role of light transmission aggregometry(LTA)in evaluating the efficacy of aspirin by comparing with thromboelastography(TEG),and to observe the consistency between the two methods.Based on the results of LTA,the possible risk factors affecting the efficacy of aspirin were evaluated.Methods Totally 240 patients admitted to Beijing Tiantan Hospital from November 2018 to October 2019 were collected and treated with dual antiplatelet drugs.Among them,165 patients were tested for TEG and LTA simultaneously.Kappa(κ)was used to evaluate the consistency of the two test methods,and relevant parameters were analyzed.Among the 240 patients,146 were diagnosed with acute ischemic stroke.These patients were divided into aspirin resistance group and aspirin non-resistance group according to the LTA test results.The clinical data and laboratory indicators of the two groups were compared,and the possible risk factors of aspirin resistance were analyzed by Logistic regression.Results LTA and TEG showed good consistency in evaluating platelet function(κ=0.543,P=0.000),and PAg-AA%detected by LTA was negatively correlated with AA%detected by TEG(r=-0.557,P=0.000).Compared with aspirin non-resistance group,aspirin resistant patients had higher d-dimer level and larger mean platelet volume(MPV),P<0.05.Multivariate Logistic regression analysis showed that D-dimer(OR=4.436,95%CI:1.810-10.868,P=0.001)and MPV(OR=2.687,95%CI:1.038-6.954,P=0.042)constituted independent risk factors for aspirin resistance.Conclusion LTA could be used as an effective and reliable method to evaluate the efficacy of aspirin in early stage.High levels of D-dimer and MPV constitute independent risk factors for aspirin resistance.

关 键 词：光学比浊法 血小板聚集率 血栓弹力图法 阿司匹林抵抗 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R446.1[医药卫生—临床医学]