血栓弹力图及基因检测技术在支架辅助栓塞颅内动脉瘤老年患者中的应用  

Application of thromboelastography and gene detection in elderly patients with intracranial aneurysms undergoing stent assisted embolization

作　　者：张芷薇 玄飞越 郑法康 李琪 李海鹏 唐华 常树峰 龚海东 Zhang Zhiwei;Xuan Feiyue;Zheng Fakang;Li Qi;Li Haipeng;Tang Hua;Chang Shufeng;Gong Haidong(Department of Neurosurgery,Hongqi Hospital Affiliated to Mudanjiang Medical University,Mudanjiang157000,Heilongjiang Province,China)

机构地区：[1]牡丹江医学院附属红旗医院神经外科,157000 [2]牡丹江医学院附属红旗医院检验科,157000 [3]河南省鹤壁市人民医院神经外科

出　　处：《中华老年心脑血管病杂志》2023年第4期340-343,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：黑龙江省卫生健康委科研课题(2020-401);“红旗科研基金”科技项目(2021HQ-03)。

摘　　要：目的分析血栓弹力图参数、氯吡格雷基因检测及阿司匹林基因检测的个体化抗血小板治疗方案对接受支架辅助栓塞老年颅内动脉瘤患者的预后。方法回顾性分析2016年2月至2021年10月牡丹江医学院附属红旗医院及鹤壁市人民医院接受支架辅助栓塞治疗的老年颅内动脉瘤患者192例。经血栓弹力图参数、氯吡格雷及阿司匹林基因检验结果调整的抗血小板治疗患者为调整组(144例),未进行检验的标准双抗血小板治疗患者为对照组(48例)。调整组继续分为:增加抗血小板药物剂量患者为增加组(20例),余下患者为非增加组(124例)。2组分别与对照组比较住院期间出血事件、血栓栓塞事件的发生情况,比较术后首次及出院前血栓弹力图参数。结果调整组与对照组的临床资料比较无显著差异(P>0.05)。非增加组出血事件的发生率显著低于对照组(2.4%vs 12.5%,P=0.029),增加组、非增加组、对照组在出院时改良的Rankin量表评分≤2分、栓塞情况比较无统计学差异(P>0.05)。调整组出院前的二磷酸腺苷(ADP)受体途径血凝块最大强度较术后首次显著升高,ADP受体途径诱导血小板聚集的抑制率较术后首次显著降低,差异有统计学意义(P<0.01)。结论血栓弹力图参数以及基因检测技术的个体化抗血小板治疗会积极影响老年颅内动脉瘤患者支架辅助栓塞术后的出血及栓塞风险。Objective To analyze the effect of individualized antiplatelet therapy based on thromboelastography parameters and results of clopidogrel and aspirin gene tests on the prognosis of elderly patients with intracranial aneurysms undergoing stent assisted coil embolization.Methods A retrospective analysis was performed on 192elderly patients with intracranial aneurysm who received stent implantation in Hongqi Hospital Affiliated to Mudanjiang Medical University and Hebi People's Hospital from February 2016to October 2021.The patients receiving antiplatelet therapy with adjustment based on thromboelastography parameters and results of clopidogrel and aspirin gene tests were assigned into the adjustment group(144cases),and those receiving standard dual antiplatelet therapy without gene test were into the control group(48cases).The adjustment group was further subdivided into the increasing subgroup(increased dose of antiplatelet drugs,20cases),and the non-increasing subgroup(remaining dose,124cases).The incidence of in-hospital bleeding events and thromboembolic events in the 2subgroups were compared with those in the control group.The parameters of thromboelastography at the first time after operation and before discharge were recorded and compared.Results There were no significant differences in basic clinical data between the adjustment group and the control group(P>0.05).The incidence of bleeding events in the non-increasing subgroup was statistically lower than that in the control group(2.4%vs 12.5%,P=0.029).At discharge,there were no obviously differences in mRS score≤2and embolism occurrence among the increasing subgroup,the non-increasing subgroup and the control group(P>0.05).In the adjustment group,the MA-ADP before discharge was higher than that after operation at the first time,and the AAi was lower than that after operation at the first time(P<0.01).Conclusion Individualized antiplatelet therapy based on thromboelastography parameters and gene detection technology will positively affect the bleeding and

关 键 词：颅内动脉瘤 血栓弹力描记术 栓塞 治疗性 基因检测 支架 

分 类 号：R743[医药卫生—神经病学与精神病学]