血栓弹力图在心脑血管病病人抗血小板治疗中的应用价值
Application value of thrombelastogram in antiplatelet therapy in patients with cardia-cerebrovascular disease
-
摘要: 目的:分析服用抗血小板药物心脑血管病病人血栓弹力图(TEG)结果,为临床治疗提供参考。方法:收集因心脑血管疾病住院病人249例,根据其服用抗血小板药物情况分为阿司匹林组(AA组,n=141)、氯吡格雷组(ADP组,n=20)、阿司匹林+氯吡格雷联合组(双联组,n=88),用血栓弹力图仪检测病人血小板抑制率,分析3组抗血小板治疗的疗效差异。结果:双联组的AA途径和ADP受体途径血小板抑制率分别为(88.47±19.69)%和(68.08±28.12)%,均高于AA组的(77.71±29.7)%和ADP组的(52.57±26.97)%(P<0.01和P<0.05)。双联组的阿司匹林抵抗和氯吡格雷抵抗发生率分别为6.82%和11.36%,均低于AA组的21.99%和ADP组的30%(P<0.01和P>0.05)。结论:采用TEG仪检测心脑血管病病人的血小板聚集抑制率有利于指导临床制定个体化的抗血小板治疗方案。阿司匹林对心脑血管病人血小板聚集的抑制作用强于氯吡格雷。接受标准剂量抗血小板治疗的心脑血管病病人存在抗血小板抵抗;阿司匹林与氯吡格雷联用抗血小板有协同作用。Abstract: Objective:To analyze the results of thrombelastography(TEG) in cardia-cerebrovascular disease patients treated with antiplatelet,and provide the reference for clinical therapy.Methods:Two hundred and forty-nine cardia-cerebrovascular disease patients were divided into the aspirin group(group AA,141cases),clopidogrel group(group ADP,20 cases) and aspirin and clopidogrel combination group(combination group,88 cases) according to the use of antiplatelet agent.The platelet inhibition rates in three groups were detected by thromboelastography,and the differences of the efficacy of antiplatelet treatment between three groups were compared.Results:The platelet inhibition rates in combination group induced by AA and ADP receptor pathway were (88.47±19.69)% and (68.08±28.12)%,respectively,which was higher than that in group AA[(77.71±29.7)%] and in group ADP[(52.57±26.97)%](P<0.01 and P<0.05).The incidence rates of aspirin and clopidogrel resistance in combination group were 6.82% and 11.36%,respectively,which was lower than that in group AA(21.99%) and group ADP(30%)(P<0.01 and P>0.05).Conclusions:The inhibition rate of platelet aggregation detected by using TEG is helpful to formulate individualized antiplatelet therapy in cardia-cerebrovascular disease patients.The effect of aspirin on the inhibition of platelet aggregation in cardia-cerebrovascular disease patients is higher than that of clopidogrel.Antiplatelet resistance is found in patients treated with standard dose of antiplatelet therapy.There is a synergistic effect in the combination use of asprin and clopidogrel in antiplatelet therapy.
-
Key words:
- cardio-cerebrovascular disease /
- thrombelastography /
- antplarelet /
- aspnirin /
- clopidogrel
-
[1] 中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南[J].中华神经科杂志,2015,48(4):154. [2] TEMPLIN C,SCHAEFER A,STUMME B,et al.Combined aspirin and clopidogrel resistance associated with recurrent coronary stent thrombosis[J].Clin Res Cardiol,2006,95(2):122. [3] YI X,LIN J,ZHOU Q,et al.Clopidogrel resistance increases rate of recurrent stroke and other vascular events in Chinese population[J].J Stroke Cerebrovasc Dis,2016,25(5):1222. [4] WANG TH,BHATT DL,TOPOL EJ,et al.Aspirin and clopidogrel resistance:an emerging clinical entity[J].Eur Heart J,2006,27(7):647. [5] FEHER G,FEHER A,PUSCH G,et al.Clinical importance of aspirin and clopidogrel resistance[J].World J Cardiol,2010,2(7):171. [6] GASPAROVIC HPETRICEVIC M,BIOCINA B. Management of antiplatelet therapy resistance in cardiac surgery[J].J Thoracic Cardiovasc Surg,2014,147(3):855. [7] HOBSON AR,PETLEY GW,DAWKINS KD,et al.A novel fifteen minutetest for assessment of individual time-dependent clotting responses to aspirin and clopidogrel using modified thrombelastography[J].Platelets,2007,18(7):497. [8] 伍陈海,谢海,陈勇.血栓弹力图指导合理输血的有效性及对患者结局的影响Meta分析[J].临床麻醉学杂志,2014,30(4):321. [9] 杨丽君,林茹,叶莉芬,等.血栓弹力图在小儿体外循环围术期的应用价值[J].中国体外循环杂志,2013,11(1):11. [10] 吉鸿,王晋龙,黎一鸣,等.血栓弹力图指导下调节肝硬化脾切除围手术期凝血功能的临床观察[J].昆明医科大学学报,2014,35(12):126 [11] 张华巍,杨庭树.血栓弹力图在冠状动脉介入治疗患者抗血小板治疗中的应用研究[J].中国循证心血管医学杂志,2013,5(1):46. [12] 张琳,齐伟哲,仇飚.血栓弹力图在出血性脑梗死患者的临床应用研究[J].北京医学,2012,34(2):119. [13] ZHAO Yan,YANG M. GW25-e0430 Thrombelastography (TEG) test to assess the anti-platelet therapy responsivity in coronary heart disease[J].J Am Coll Cardiol,2014,64(16):C152. [14] 邱石,苗凤茹,吴涛,等.阿司匹林与氯吡格雷抗血小板作用的Meta分析[J].山东医药,2014,54(22):40. [15] 林志坚,庄君,赵静,等.脑梗死患者抗血小板药物抵抗的发生率及相关因素研究[J].医学研究杂志,2014,43(9):66. [16] 陈昕朦,金晶,黄民,等.CYP2C19、P2Y12基因多态性与缺血性脑卒中患者氯吡格雷抵抗的相关性研究[J].中国药师,2014,17(6):885.
计量
- 文章访问数: 3820
- HTML全文浏览量: 464
- PDF下载量: 53
- 被引次数: 0