摘要
目的以流式细胞术(FCM)为参照,评价血栓弹力图(TEG)对经皮冠状动脉介入治疗(PCI)术后患者氯吡格雷反应性的评价价值。方法入选2014年1月~2016年1月于江苏省淮安市淮安医院确诊冠状动脉粥样硬化性心脏病(冠心病)并实施PCI术的患者75例,术后同时服用阿司匹林和氯吡格雷抗血小板治疗。术后第7 d采用FCM测定患者血浆中血小板膜糖蛋白纤维蛋白原受体-1(PAC-1)和血小板P选择素(CD62P)表达率,采用TEG检测患者二磷酸腺苷(ADP)抑制率,记录并分析患者对氯吡格雷的反应性。同时进行1年的随访,记录不同氯吡格雷反应性患者缺血及出血事件发生情况。结果根据FCM检测结果,血小板活化程度高表达(氯吡格雷反应性差)21例(28.0%),中等表达(氯吡格雷反应性一般)36例(48.0%),低表达(氯吡格雷反应性好)18例(24.0%)。TEG结果表明,当ADP抑制率<38.9%时,提示氯吡格雷反应性差,95%CI为0.952~0.982,ROC曲线下面积为0.943(P<0.05)。结合ADP抑制率<38.9%,22例患者氯吡格雷反应性较差,因此ADP抑制率与PAC-1、CD62P表达率拟合度较高。随访期间,氯吡格雷反应性好的患者缺血事件发生率低于其余两组(P<0.05)。结论对于冠心病PCI术后患者,当ADP抑制率为<38.9%为氯吡格雷反应性差,与FCM检测PAC-1和CD62P表达率所得结果拟合度较高,提示患者存在氯吡格雷抵抗,可为指导个体化治疗提供新的思路。
Objective To review the diagnostic value of thrombelastogram （TEG） to clopidogrel clopidogrel, taken flow cytometry （FCM） as a reference, in patients with coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. Methods CHD patients （n=75） undergone PCI were chosen from the Huai’an Hospital of Huai’an City in Jiangsu Province from Jan. 2014 to Jan. 2016, and given aspirin and clopidogrel for anti-platelet treatment. After PCI for 7 d, the expressions of platelet membrane glycoprotein fibrinogen receptor-1 （PAC-1） and cluster of differentiation 62 platelet （CD62P） were detected by using FCM, inhibition rate of adenosine diphosphate （ADP） were detected by using TEG, and clopidogrel reactivity was recorded and analyzed. Meanwhile the patients were followed up for 1 y, the incidence of ischemia and bleeding events were recorded in patients with different clopidogrel reactivities. Results The results of FCM showed that there were 21 cases （28.0%） with high expression of platelet activation （poor clopidogrel reactivity）, 36 （48.0%） with medium expression （ordinary clopidogrel reactivity） and 18 （24.0%） with low expression （good clopidogrel reactivity）. The results of TEG showed that when ADP inhibition rate〈38.9%, clopidogrel reactivity was poor （95%CI： 0.952~0.982） and area under ROC was 0.943 （P〈0.05）. According to ADP inhibition rate〈38.9%, there were 22 cases with poor clopidogrel reactivity, so ADP inhibition rate had higher degree of fitting with expressions of PAC-1 and CD62P. During the follow-up period, the incidence of ischemia events was lower in patients with good clopidogrel reactivity than that in those with ordinary or poor clopidogrel reactivity （P〈0.05）. Conclusion ADP inhibition rate〈38.9% indicates poor clopidogrel reactivity and higher degree of fitting with expressions of PAC-1 and CD62P detected by FCM in CHD patients after PCI, which presents patients have clopidogrel resistance and
出处
《中国循证心血管医学杂志》
2017年第12期1474-1477,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
冠心病
经皮冠状动脉介入治疗
血栓弹力图
流式细胞术
Coronary heart disease
Percutaneous coronary intervention
Thrombelastogram
Flow cytometry
