PL-11两种诱导剂监测健康人服用氯吡格雷后的血小板功能变化

Role of PL-11 inducers in monitoring platelet function in healthy subjects after taking clopidogrel

目的：评价新型血小板功能检测方法PL-11两种诱导剂对氯吡格雷短期效应的监测。方法与以二磷酸腺苷（adenosine diphosphate，ADP）诱导的光比浊法（ADP-LTA）为参照，比较ADP（ADP-PL-11）与胶原（Col-PL-11）诱导的PL-11对健康人服用氯吡格雷后血小板功能变化的监测。结果25名健康青年男性平均年龄（27.5±3.7）岁，服药6 d后，血小板功能均有所降低。Col-PL-11在基础值范围64.7%-83.6%（95%PI），ADP-LTA结果在基础值范围是65.9%-89.1%（95%PI），ADP-PL-11为67.2%-86.8%（95%PI）。服药前后Col-PL-11结果存在部分重叠区域。各方法相关性分别为ADP-PL-11 vs LTA， r=0.757，P＜0.001；ADP-PL-11 vs Col-PL-11，r=0.764，P＜0.001；Col-PL-11 vs LTA，r=0.521，P=0.009。以ADP活化LTA结果在服药后比服药前基础值降低至少10%（＞10%）为氯吡格雷低反应性的标准，ROC分析得到ADP-PL-11（临界值66%）敏感度和特异性分别为84.6%，88.2%；Col-PL-11（60.0%）敏感度和特异性分别为69.2%，70.6%。结论 PL-11检测氯吡格雷治疗时ADP比胶原具有较高的敏感度，ADP-LTA与ADP-PL-11之间结果可能存在可交换性，使ADP激活的PL-11检测可能成为替代经典光比浊法的血小板功能监测方法。

Objective To assess the role of PL-11 inducers in monitoring platelet function in healthy subjects after taking clopidogrel. Methods The role of PL-11 inducers, ADP and collagen, in monitoring platelet function in healthy subjects after taking clopidogrel was compared with light turbidimetric analysis （LTA） as its reference. Results The platelet function decreased in 25 healthy male young subjects with a mean age of 27.5±3.7 years 6 days after taking clopidogrel. The baseline value for PL-11 inducer collagen, LTA and PL-11 inducer ADP was 65.9%-89.1% （95%PI）, 67.2%-86.8% （95%PI）, 64.7%-83.6% （95%PI）, respectively. An overlapped value was found before and after taking clopidogrel. ADP was correlated with LTA （r=0.757, P〈0.001） and collagen （r=0.764, P〈0.001）, collagen was correlated with LTA （r=0.521, P=0.009）. The baseline value of LTA was at least 10%lower after taking clopidogrel than before taking clopidogrel, which could thus be used as the criterion for clopidogrel reactivity. ROC analysis showed that the cut-off value for ADP and collagen was 66%and 60.0%, respectively. The sensitivity and specificity of ADP and collagen were 84.6%and 88.2%, 69.2%and 70.6%, respectively. Conclusion The sensitivity of ADP is higher than that of collagen in monitoring the platelet function in healthy subjects after taking clopidogrel. The sensitivity of LTA and ADP is interchangeable, and can thus become a classic light turbidimetry for platelet function monitoring.