摘要
目的探讨流式细胞术监测血小板活化指导颅内支架介入治疗术后病人抗血小板治疗的价值。方法选择2013年1月至2016年4月支架介入治疗术后病人1 792例,采集空腹静脉血,用20μmol/L ADP激活5 min,应用流式细胞仪监测CD62P阳性率,范围控制在20.0%~50.0%。所有病人随访1年。结果 1792例中,无不良事件1691例,出血96例,再梗死5例。无不良事件组ADP激活后CD62P阳性率[(42.34±19.35)%]显著低于再梗死组[(83.64±6.41)%;P<0.05],但是明显高于出血组[(11.32±3.96)%;P<0.05]。ADP激活后CD62P阳性率<20.0%有247例,20.0%~50.0%有1195例,>50.0%有345例。<20.0%组出血发生率明显增高(P<0.05),>50.0%组再梗死发生率明显增高(P<0.05)。20.0%~50.0%组不良事件发生率最低(P<0.05)。结论应用20μmol/L的ADP激活血小板5 min,采用流式细胞仪监测CD62P阳性率,可精准指导颅内支架介入治疗术后病人抗血小板治疗,其安全有效范围为20.0%~50.0%。
Objective To explore the value of platelet activation monitoring(PAM)using flow cytometry(FCM)to guide the antiplatelet therapy in patients after intracranial stenting.Methods The fasting venous blood were collected from 1792 patients who underwent intracranial stenting from January 2013 to April 2016.After activation using 20μmol/L ADP for 5 minutes,the CD62P positive rate was detected by FCM,and the rate was controlled within 20.0%~50.0%.All the patients were followed up for 1 year.Results Of 1792 patients,1691 had no adverse events,96 had bleeding,and 5 had re-infarction.The positive rate of CD62P in the bleeding group[(11.32±3.96)%]was significantly lower than that[(42.34±19.35)%]in the no adverse event group(P<0.05),which was significantly lower than that[(83.64±6.41)%]in the re-infarction group(P<0.05).The positive rate of CD62P was<20.0%in 247 patients,20.0%~50.0%in 1195 patients,and>50.0%in 345 patients.The incidence of bleeding was significantly higher in the<20.0%group than those in 20.0%~50.0%and>50.0%groups(P<0.05).The incidence of re-infarction was significantly higher in the>50.0%group than those in<20%and 20%~50%groups(P<0.05).The incidence of adverse events was significantly lower in the 20.0%~50.0%group than those in>50%and<20%groups(P<0.05).Conclusions Using the FCM to monitor the positive rate of CD62P after activation for 5 minutes by 20umol/L ADP can accurately guide the anti-platelet therapy for patients after intracranial stenting,and the safe and effective range of the positive rate of CD62P is 20.0%~50.0%.
作者
李芳
吴颖涛
马廉亭
卢文婕
杨李
LI Fang;WU Ying-tao;MA Lian-ting;LU Wen-jie;YANG Li(Department of Clinical Laboratory,General Hospital of Central Theater Command,PLA,Wuhan 430070,China;Department of Neurosurgery,General Hospital of Central Theater Command,PLA,Wuhan 430070,China;Department of Hemotology and Oncology,Wuhan Children's Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430016,China)
出处
《中国临床神经外科杂志》
2020年第8期525-527,共3页
Chinese Journal of Clinical Neurosurgery
