用血栓弹力图评价阿司匹林及氯吡格雷在缺血性卒中患者中血小板抑制效应的研究

Evaluation of inhibitory effects of different antiplatelet agents on platelets in ischemic cerebral vascular disease patients by thrombelastogram

目的用血栓弹力图评价缺血性卒中患者正规使用阿司匹林及氯吡格雷后血小板抑制率的变化。方法血栓弹力图检测我院123例住院患者抗血小板药物治疗后花生四烯酸(AA)通路和ADP受体途径诱导的血小板抑制率,患者抗血小板药物治疗包括阿司匹林组(n=7)、氯吡格雷组(n=8)、阿司匹林+氯吡格联合组(n=108)。结果 123例患者中,阿司匹林组AA诱导的血小板抑率为(87.04±22.71)%,氯吡格雷组ADP诱导的血小板抑制率平均值为(46.61±24.43)%,阿司匹林+氯吡格雷组AA和ADP诱导的血小板抑制率为分别(77.87±27.98)%和(50.23±29.27)%。服用阿司匹林和氯吡格雷的患者分别有115和116例,其AA和ADP途径血小板抑制率分别为(78.42±27.69)%;(49.99±28.88)%,差异具有显著统计学意义(P=0.000)。其中对阿司匹林和氯吡格雷敏感者(血小板抑制率≥50%)分别为97例(84.34%)和89例(75.72%),而不敏感者(血小板抑制率<50%)分别为18例(15.65%)和27例(23.28%),两种药物疗效间差异无显著统计学意义(χ2=3.706,P=0.054)。结论服用100mg/d阿司匹林,在绝大多数缺血性脑血管病患者中能产生较强的血小板抑制效应,而服用75mg/d氯吡格雷对血小板抑制稍弱,但多数患者仍能达有效的血小板抑制作用。

Objective To determine inhibitory effects of different forms of antiplatelet agents on platelets, thromboelastograph（TEG） was used to assess the inhibitory rates of adenosine diphosphate（ADP） receptors and arachidonic acid （AA） pathway in platelets. Methods 123 ischemic stroke hospitalized patients were included in three groups：group aspirin, clopidogrel and aspirin ＋ clopidogrel. The inhibitory rates of AA and ADP receptor pathway in platelets were detected by TEG and analyzed with SPSS version 15.0. Results Platelet inhibition in response to aspirin was 87.04 ± 22.71% in group aspirin,and 77.87% ＋ 27.98% in group aspirin ＋ clopidogrel. Platelet inhibition in response to clopidogre was 79.97 % ＋ 28.52% in group clopidogrel, and 46.61 ± 24.43% in group aspirin ＋ clopidogrel. There were 115 and 116 pa- tient treated with aspirin and clopidogrel, respectively. Among them, patients with platelet inhibitory rate I〉 50% were 97 and 89 in aspirin and clopidogrel treatment, respectively. 19 and 27 patients treated with aspirin and clopidogrel had platelet inhibition 〈 50%. The difference of theraputic efficacy between the two agents was not significant（ Pearson chi2 = 3. 7036, P = 0.054）. Conclusion Daily 100mg of aspirin induced significant platelet inhibtion in most patients. Daily 75mg clopidogrel produced a relatively mild but effective platelet inhibition.