基因多态性检测及血栓弹力图对中/低应答ACS患者抗血小板治疗方案的指导作用研究  

Study on role of gene polymorphism testing and thromboelastography in guiding antiplatelet regimens in patients with medium/low response ACS

作　　者：张旭[1] ZHANG Xu(Huizhou Central People's Hospital,Huizhou 516000,China)

机构地区：[1]惠州市中心人民医院,516000

出　　处：《中国实用医药》2024年第16期80-83,共4页China Practical Medicine

基　　金：惠州市科技计划项目(项目编号:221014156940901)。

摘　　要：目的研究基因多态性检测与血栓弹力图(TEG)对临床指导中/低应答急性冠状动脉综合征(ACS)患者抗血小板治疗方案的意义。方法选取经基因多态性检测为阿司匹林中/低应答的ACS患者97例,根据TEG检测结果将患者分为阿司匹林低应答组(TEG未达标且有缺血表现,59例)及阿司匹林中应答组(TEG达标且无缺血表现,38例);根据用药方案不同将阿司匹林低应答组分为阿司匹林低应答1组(20例)、阿司匹林低应答2组(18例)、阿司匹林低应答3组(21例)。阿司匹林中应答组患者服用阿司匹林+氯吡格雷,阿司匹林低应答1组服用阿司匹林+氯吡格雷,阿司匹林低应答2组服用吲哚布芬+氯吡格雷,阿司匹林低应答3组服用阿司匹林+吲哚布芬+氯吡格雷。对比四组患者用药8 h、12 h以及7 d后的血小板抑制率(AA%)、血浆血栓素A_(2)(TXA_(2))水平、尿11-脱氢血栓烷B_(2)(11-dh-TXB_(2))水平以及再出血率。结果用药8 h、12 h、7 d后,阿司匹林中应答组及阿司匹林低应答2组患者AA%分别为(63.35±4.17)%、(67.19±4.06)%、(72.35±4.01)%及(62.79±4.14)%、(66.98±4.01)%、(71.96±3.95)%,均高于阿司匹林低应答1组的(55.36±4.06)%、(59.17±4.01)%、(63.69±3.72)%及阿司匹林低应答3组的(55.19±4.04)%、(60.11±4.02)%、(61.15±3.56)%,差异有统计学意义(P<0.05)。阿司匹林中应答组与阿司匹林低应答2组、阿司匹林低应答1组与阿司匹林低应答3组AA%对比,差异无统计学意义(P>0.05)。用药8 h、12 h、7 d后,阿司匹林中应答组患者的尿11-dh-TXB_(2)分别为(621.23±87.23)、(577.26±81.29)、(521.35±82.36)pg/ml,阿司匹林低应答2组患者的尿11-dh-TXB_(2)分别为(623.14±82.26)、(570.36±80.25)、(523.36±80.36)pg/ml,均低于阿司匹林低应答1组的(677.21±82.25)、(623.36±80.23)、(577.49±78.25)pg/ml及阿司匹林低应答3组的(680.15±83.14)、(625.69±82.36)、(580.19±80.15)pg/ml;阿司匹林中应答组患者的血浆TXA_(2)分别为(425.36�Objective To study the significance of gene polymorphism testing and thromboelastography(TEG)in guiding antiplatelet regimens in patients with medium/low response acute coronary syndrome(ACS).Methods A total of 97 patients with ACS who were diagnosed as having medium/low aspirin response by genetic polymorphism testing were divided into aspirin low response group(thromboelastography not standardized and ischemic manifestations,59 cases)and aspirin medium response group(thromboelastography standardized and no ischemic manifestations,38 cases)according to TEG test results.The aspirin low response group was divided into aspirin low response group 1(20 cases),aspirin low response group 2(18 cases),and aspirin low response group 3(21 cases)according to the different medication regimens.Patients in the aspirin medium response group took aspirin+clopidogrel,aspirin low response group 1 took aspirin+clopidogrel,aspirin low response group 2 took indobufen+clopidogrel,and aspirin low response group 3 took aspirin+indobufen+clopidogrel.The arachidonic acid inhibition rate(AA%),plasma thromboxane A_(2)(TXA_(2))level,urinary 11-dehydrothromboxane B_(2)(11-dh-TXB_(2))level after 8 h,12 h,and 7 d of medication,and rebleeding rate were compared among the four groups.Results After 8 h,12 h and 7 d of medication,the AA%of aspirin medium response group and aspirin low response group 2 were(63.35±4.17)%,(67.19±4.06)%,(72.35±4.01)%and(62.79±4.14)%,(66.98±4.01)%,(71.96±3.95)%,which were higher than(55.36±4.06),(59.17±4.01),(63.69±3.72)%in aspirin low response group 1,and(55.19±4.04)%,(60.11±4.02)%,(61.15±3.56)%in aspirin low response group 3.The difference was statistically significant(P<0.05).There was no statistically significant difference in AA%between aspirin medium response group and aspirin low response group 2,as well as between aspirin low response group 1 and aspirin low response group 3(P>0.05).After 8 h,12 h and 7 d of medication,the urinary 11-dh-TXB_(2)of patients in the aspirin medium response group were(621

关 键 词：急性冠状动脉综合征 基因多态性检测 血栓弹力图 抗血小板方案 再出血 

分 类 号：R541.4[医药卫生—心血管疾病]