3种方法检测经皮冠状动脉介入治疗术后患者氯吡格雷的药效学

Abstract

目的 比较光学比浊法(ETA)、血栓弹力图法(TEG)和VerifyNow检测系统对患者血小板反直性的能力及影响因素.方法 人选174例经皮冠状动脉介入治疗(PCI)术后且口服阿司匹林和氯吡格雷双联抗血小板治疗的患者为研究对象.用LTA法、TEG法和VerifyNow法检测血小板聚集功能.结果 LTA组、TEG组和VerifyNow组的高血小板反应性(HPR)检出率分别为56.64％(64例/113例),60.38％(32例/52例)和17.24％(15例/87例),LTA法和TEG法的HPR检出率比较,差异无统计学意义(P＞0.05),VerifyNow法的HPR检出率与LTA和TEG法比较,差异均有统计学意义(均P＜0.001).结论 VerifyNow法相比于LTA法和TEG法可能存在高估氯吡格雷抗血小板疗效的问题,3种方法对于临床结局的预测价值有待随访结果验证.

Objective To compare the ability and influence factors of three platelet function tests:light transmission aggregometry (LTA),thrombelastograph (TEG) and VerifyNow.Methods A total of 174 patients underwent percutaneous coronary intervention (PCI) and platelet function test were enrolled.Platelet function were tested by LTA,TEG and VerifyNow.Results Patients were found to be high platelet reactivity (HPR) by LTA (56.64％,64 cases/113 cases),TEG(60.38％,32 cases/52 cases),VerifyNow (17.24％,15 cases /87 cases).There were no significant differences observed between TEG and LTA (P ＞0.05).VerifyNow identified lower HPR proportion compared with TEG and LTA (all P ＜ 0.001).Conclusion Compared with LTA and TEG,VerifyNow identified lower HPR proportion and may overestimate the effectiveness of clopidogrel.We will follow the patients to study the predictive capability of three tests.