VerifyNow-P2Y12法和光密度比浊法检测血小板高反应与预测氯吡格雷治疗老年冠状动脉性心脏病患者经皮冠状动脉介入术后临床缺血事件的意义

A comparison of VerifyNow-P2Y12 Assay and light transmission aggregometry in detecting antiplatelet function of clopidogrel in elderly patients after percutaneous coronary intervention

目的明确VerifyNow—P2Y12法和光密度比浊法（LTA）检测老年冠状动脉性心脏病（简称冠心病）患者氯吡格雷疗效的相关性，并比较这两种方法预测老年冠心病患者经皮冠状动脉介入治疗（PCI）术后临床缺血事件的意义。方法连续入选160例年龄≥60岁的冠心病植入冠状动脉支架术患者，服用氯吡格雷≥1周后，采用VerifyNow法和LTA同时检测二磷酸腺苷（ADP）诱导的血小板聚集功能，将VerifyNow法检测出血小板聚集反应单位（PRU）≥230或LTA检测出最大血小板聚集率（MPAR）≥46％定义为治疗后血小板高反应（HPR）。采用双变量相关分析和简单线性回归分析评估两种方法检测结果的相关性。所有患者随访6个月，比较两种方法检测出的HPR预测临床缺血事件的敏感性。结果采用VerifyNow法检测出HPR患者44例（27．5％），LTA检测出HPR患者52例（32．5％），两者间的差异无统计学意义（P〉0．05）。PRU与MPAR值呈正相关（r=0．62315，P=0．037），线性回归方程Y（VerifyNow法）=2．015X（LTA）＋110．2。VerifyNow法检测出的HPR患者中总临床缺血事件的发生率（27．1%）显著高于同法检测的非HPR患者（6．0％，OR=6．53，95%CI为2．61～16．32，P=0．000），而LTA检测出的HPR患者中总临床缺血事件的发生率（17．2％）有高于同法检测的非HPR患者（9．3％）的趋势，但差异无统计学意义（OR=2．33，95％CI为0．92～5．91，P=0．074）。结论VerifyNow法和LTA均可检测氯吡格雷治疗老年冠心病患者PCI术后HPR。HPR患者PCI后6个月的临床缺血事件发生率高于非HPR者；VerifyNow法检测出的HPR预测临床缺血事件的敏感性高于LTA检测出的HPR。

Objective To analyze the correlation between the testing results of VerifyNow-P2Y12 Assay and light transmission aggregometry （LTA） in elderly patients treated with clopidogrel following percutaneous coronary intervention （PCI） and to compare the sensitivity of the two methods in predicting clinical ischemic events. Methods A total of 160 elderly patients （60 years old and above） who underwent PCI and had taken clopidogrel at least for 7 days were enrolled in the study. Their adenosine diphosphate （ADP）-induced platelet aggregative function was tested by both VerifyNow-P2Y12 and LTA. High on-treatment platelet reactivity （HPR） was defined as 5 μmol/L ADP induced maximal platelet aggregation （MPAR） ≥46% in LTA and P2Y12 reaction units （PRU）≥230 in VerifyNow-P2Y12 Assay. The correlation between results of the two assays was analyzed by bivariate correlation analysis and linear regression. All the patients had been followed up for at least 6 months. The sensitivity of HPRs measured by the two different assays in predicting clinical ischemic events was compared. Results HPR was found in 44 （27.5%） patients by VerifyNow-P2Y12 and in 52 （32.5% ） patients by LTA （P〉 0.05）. MPAR was positively related to PRU （r=0. 62315, P = 0. 037）. The linear regression equation was Y （VerifyNow-P2Y12） =2. 015X （LTA） ＋ 110.2. The incidence of clinical ischemic events in VerifyNow-HPR group was significantly higher than that in non VerifyNow-HPR group （27. 1% vs. 6.0%, OR = 6.53, 95% CI 2.61 - 16.32, P--0. 000）. But there was no significant difference in the incidence of clinical ischemic events between LTA-HPR group and non LTA-HPR group （17.2% vs. 9.3%, OFt=2.33, 95%C1.. 0.92-5.91,P=0.074）. Conclusion Both VerifyNow-P2Y｜2 Assay and LTA are effective in identifying HPR in the elderly patients treated with clopidegrel after PCI. The incidence of clinical ischemic events in the patients with HRP is significantly higher than that in the patients without HRP. Compared with LTA, VerifyNow-P2Y12 Assay has higher sensitivity in predicting clinical ischemic events during clopidogrel therapy in elderly patients.