高岭土-血栓弹力图评价阿司匹林和氯吡格雷的抗血小板效果

Kaolin-Thromboelastograph for Evaluation of anti-Platelet Effect by Aspirin and Clopidogrel

目的用高岭土-血栓弹力图评价阿司匹林和氯吡格雷的抗血小板效果。方法观察组97例,联用阿司匹林和氯吡格雷;对照组22例,未服此二药。检测两组患者的高岭土-血栓弹力图;并检测观察组血小板抑制率。结果两组患者高岭土-血栓弹力图K时间、α角、MA和TMA均无差别(P>0.05),观察组R时间较短(P<0.01);两组患者K时间、α角、MA异常患者的发生率相似(P>0.05);根据观察组花生四烯酸途径抑制率做3分位亚组,低、中、高分位亚组的R时间、K时间、α角、MA和TMA值均无差别(P>0.05);ADP受体抑制率也有类似情况,但高分位亚组TMA较长(P=0.017)。花生四烯酸途径抑制率和ADP受体抑制率呈直线性正相关(r=0.486,P<0.001)。结论高岭土-血栓弹力图评价阿司匹林和氯吡格雷抗血小板效果价值有限,阿司匹林对血小板花生四烯酸途径抑制率与氯吡格雷对ADP受体抑制率存在一定正相关。

Objective To evaluate the anti-platelet effect by aspirin and clopidogrel with kaolin-throm- boelastograph. Methods The observed group included 97 patients with acute coronary syndrome treated with aspirin （100 mg） plus clopidogrel （75 rag） daily. The control group were composed of 22 cases with stable coronary heart disease and not given these two medicines. Kaolin-thromboelastography was conducted in both groups. Platelet inhibition rates were detected in the observed group. Results No significance was seen in K time, o~ angle, MA and TMA between the observed and control groups （P 〉 0.05 ） , but the observed group had shorter R time （P 〈 0.01 ）. Percentage of patients having abnormal K time ,α angle , MA was similar in both the observed and control groups （ P 〉 0.05 ）. Patients in the observed group were divided into 3 tertile subgroup according to the inhibition rate of platelet arachidonic acid pathway, and there is no significance in R time, K time, α angle, MA and TMA between the low, middle and upper tertile subgroups （ P 〉 0.05 ）. Similar phenomena also existed for the inhibition rate of platelet ADP receptor pathway, except for a longer TMA （P = 0. 017 ）. There was positively linear correlation between the inhibition rates of platelet arachidonic acid path- way and ADP receptor pathway（ r = 0. 486, P 〈 0. 001 ）. Conclusion There is limited role for kaolin-throm- boelastograph to evaluate the anti-platelet effect by aspirin and clopidogrel. Positive linear correlation existed between the inhibition rates of arachidonic acid pathway and that of ADP receptor pathway.