血栓弹力图指导抗血小板治疗对缺血性脑卒中二级预防效果影响的研究  

Study on the effect of thromboelastography-guided antiplatelet therapy on the secondary prevention of cerebral ischemic stroke

作　　者：刘华钊[1] 钟建新[1] 陈克强[1] 郑红丽 温清艳 LIU Hua-zhao;ZHONG Jian-xin;CHEN Ke-qiang(Department of Internal Medicine-Neurology,Jiangmen Central Hospital,Jiangmen 529000,China)

机构地区：[1]江门市中心医院神经内科,529000

出　　处：《中国实用医药》2021年第2期7-10,共4页China Practical Medicine

基　　金：广东省江门市医疗卫生领域科技计划(项目编号:2017A1023)。

摘　　要：目的分析血栓弹力图(TEG)指导抗血小板治疗在急性缺血性脑卒中(CIS)二级预防中的应用效果。方法86例CIS患者,随机分为TEG组与常规组,每组43例。常规组接受常规抗血小板治疗,TEG组接受TEG指导下抗血小板治疗。比较两组抗血小板药物抵抗发生率、血小板计数(PLT)、花生四烯酸诱导的血小板抑制率(AA%)及二磷酸腺苷诱导的血小板抑制率(ADP%)水平变化,分析CYP2C19基因型与ADP%水平的相关性。结果治疗7 d后,两组阿司匹林抵抗及氯吡格雷抵抗发生率比较,差异无统计学意义(P>0.05)。治疗前、治疗7 d后、治疗14 d后,两组PLT水平均呈降低趋势,差异有统计学意义(P<0.05)。常规组AA%水平呈降低趋势,TEG组AA%水平呈先降低后升高趋势,差异有统计学意义(P<0.05)。常规组ADP%水平呈降低趋势,TEG组ADP%水平呈先降低后升高趋势,差异有统计学意义(P<0.05)。治疗14 d后,TEG组PLT水平(228.28±17.16)×10^9/L低于常规组的(237.31±18.52)×10^9/L,差异有统计学意义(P<0.05)。TEG组AA%水平高于常规组,差异有统计学意义(P<0.05)。TEG组ADP%水平高于常规组,差异有统计学意义(P<0.05)。经Pearson相关性分析显示,CYP2C19基因型代谢程度与ADP%水平呈正相关(r=0.692,P<0.05)。结论在CIS二级预防中TEG指导下应用抗血小板药物可有效的改善血小板药物抵抗,提高抗血小板治疗效果。Objective To analyze the practical effect of thromboelastography(TEG)-guided antiplatelet therapy on the secondary prevention of cerebral ischemic stroke(CIS).Methods A total of 86 CIS patients were randomly divided into TEG group and conventional group,with 43 cases in each group.The conventional group received conventional antiplatelet therapy,and the TEG group received antiplatelet therapy under the guidance of TEG.The incidence of antiplatelet drug resistance,platelet count(PLT),arachidonic acid-induced platelet inhibition rate(AA%),and adenosine diphosphate-induced platelet inhibition rate(ADP%)level changes were compared between the two groups,and the correlation between CYP2 C19 genotype and ADP%level was analyzed.Results 7 d after treatment,there was no statistically significant difference in incidence of aspirin resistance and clopidogrel resistance between the two groups(P>0.05).Before treatment,7 d and 14 d after treatment,the PLT level of the two groups showed a downward trend,and the difference was statistically significant(P<0.05).The level of AA%in the conventional group showed a downward trend,while the level of AA%in the TEG group decreased first and then increased,the difference was statistically significant(P<0.05).The level of ADP%in the conventional group showed a downward trend,while the level of ADP%in the TEG group decreased first and then increased,the difference was statistically significant(P<0.05).14 d after treatment,the PLT level(228.28±17.16)×10^9/L of TEG group was lower than(237.31±18.52)×10^9/L of the conventional group,and the difference was statistically significant(P<0.05).The AA%level of TEG group was higher than that of conventional group,and the difference was statistically significant(P<0.05).The ADP%level of TEG group was higher than that of conventional group,and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that the degree of metabolism of CYP2 C19 genotype was positively correlated with the level of ADP%(r=0.692,P<0.05).Co

关 键 词：血栓弹力图 抗血小板治疗 急性缺血性脑卒中 二级预防 

分 类 号：R743.3[医药卫生—神经病学与精神病学]