轻型缺血性脑卒中患者在氯吡格雷治疗前后血小板功能检测与血小板膜受体水平的相关性  

The Correlation Between Platelet Function Test and Platelet Membrane Receptor Levels in Patients Before and After Clopidogrel Treatment

作　　者：鲁作华 刘兴晖[1] 刘倩倩 吴菲菲[2] LU Zuohua;LIU Xinghui;LIU Qianqian;WU Feifei(The Department of Clinical Laboratory,Gongli Hospital of Pu Dong New Area,Shanghai 200135,China;Neurology,Gongli Hospital of Pu Dong New Area,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院,检验医学部,上海200135 [2]上海市浦东新区公利医院,神经内科,上海200135

出　　处：《标记免疫分析与临床》2023年第3期397-403,451,共8页Labeled Immunoassays and Clinical Medicine

基　　金：浦东新区卫生健康委员会卫生科技项目(编号:PW2020A-44);浦东新区卫生系统重点学科群建设资助项目(编号:PWZxq2022-8)。

摘　　要：目的探讨氯吡格雷治疗前后血小板功能与血小板膜受体P2Y12表达水平的相关性,明确血小板功能检测的临床效用。方法收集2021年2月至2021年12月上海市浦东新区公利医院神经内科病区确诊轻型缺血性脑卒中患者143例,并随访180d记录终点事件。以ADP诱导血小板聚集抑制率<10%为高反应组,≥10%为非高反应组;与以ADP诱导血小板聚集抑制率<30%为高反应组;≥30%为非高反应组进行基本参数和实验室指标的比较。对P2Y12抑制率可能的相关因素进行Spearman相关性分析,并对其进行二分类Logistic回归分析。应用Kaplan-Meier生存曲线和log-rank检验分析缺血性心血管事件的危险因素。结果两种不同分组中,ADP(7)、P2Y12(7)、P2Y12抑制率、MA(7)、MA抑制率比较差异有统计学意义(P<0.05)。P2Y12抑制率与血小板聚集抑制率存在中度的正相关关系,相关系数为0.543,P<0.001。血小板抑制率小于30%是P2Y12抑制率小于6%、11.7%和17.4%的独立预测因子(OR=0.199,95%CI 0.050~0.784,P=0.021;OR=7.095,95%CI 2.809~17.923,P<0.001;OR=9.254,95%CI 2.843~30.114,P<0.001)。生存分析中发现以P2Y12抑制率小于中位数11.7%评估治疗后缺血性心血管事件存在预测价值(P=0.041),差异有统计学意义。结论以ADP诱导血小板抑制率小于30%作为血小板高反应性定义标准能够较敏感地反映治疗后P2Y12水平的变化,临床缺血性心血管事件的预防可能从中获益。Objective To investigate the correlation of platelet function testing and the platelet membrane receptor P2Y12 expression level before and after clopidogrel treatment,and to clarify the clinical utility of platelet function testing.Methods 143 patients with mild ischemic stroke diagnosed in the Neurology Department of Gongli Hospital,Shanghai Pudong New District,were collected from February,2021 to December,2021,and the endpoint events were recorded for 180 days.ADP induced platelet aggregation inhibition rate<10%was considered as the high response group,while≥10%as the non-high response group;Also,ADP<30%was defined as the high response group,while≥30%as the non-high response group for comparing basic parameters and laboratory indicators.Spearman correlation analysis was performed to identify potential related factors of P2Y12 inhibition rate,and it was used for a dichotomous logistic regression analysis.Kaplan-Meier survival curve and the log-rank test were applied to analyze the risk factors for ischemic cardiovascular events.Results ADP(7),P2Y12(7),P2Y12,P 2 Y 12,MA(7)and MA were significantly different(P<0.05).There was a moderate positive correlation between the inhibition rate of P2Y12 and that of platelet aggregation,with a correlation coefficient of 0.543,P<0.001.ADP induction of less than 30%were independent predictors of less than 6%,11.7%and 17.7%of P2Y12 inhibition(OR=0.199,95%CI 0.050-0.784,P=0.021;OR=7.095,95%CI 2.809-17.923,P<0.001;OR=9.254,95%CI 2.843-30.114,P<0.001).In the survival analysis,the predictive value of P2Y12 inhibition was 11.7%(P=0.041).Conclusion The platelet inhibition rate of less than 30%as the defining criterion of platelet hyperreactivity can reflect changes of P2Y12 levels after the treatment,including the prevention of clinical ischemic cardiovascular events.

关 键 词：血小板功能检测 血小板膜受体 缺血性脑卒中 氯吡格雷 

分 类 号：R446.11[医药卫生—诊断学]