血栓弹力图在冠心病抗血小板治疗中的临床应用

Clinical application of thromboelastogram in antiplatelet treatment of coronary heart disease

目的探讨血栓弹力图在冠状动脉介入术患者抗血小板治疗中的应用价值。方法入选90例行冠状动脉介入治疗患者,其中稳定性心绞痛(SAP)、不稳定性心绞痛(UAP)和急性心肌梗死(AMI)患者各30例。所有患者均进行血栓弹力图(TEG)以及凝血功能检测,比较3组患者TEG指标和凝血功能指标及抗血小板治疗反应性差异。结果 SAP组、UAP组、AMI组3组患者凝血反应时间(R),血凝块成形时间(K),MA后30min振幅减少百分率(LY30),活化部分凝血活酶时间(APTT),凝血酶时间(TT),国际标准化比较值(INR);水平均值逐渐下降,描记图最大曲线弧度作切线与水平线的夹角(Angle),描记图最大幅度(MA),凝血指数(CI),纤维蛋白原(FIB),D-二聚体(D-D)水平均值逐渐增高,差异有统计学意义(P均<0.01～0.05)。SAP组、UAP组、AMI组三组患者TEG图高凝图形分别为0.0%,33.3%,50.0%,AMI组患者高凝图形发生率明显多于SAP组及UAP组,差异有显著统计学意义(P<0.05)。与抗血小板药物反应正常组(9.2%)比较,抗血小板药物反应低下组(20.0%)患者3个月内缺血心脏事件发生率明显增高,差异有统计学意义(χ2=4.347,P<0.05)。结论血栓弹力图检测有助于指导冠状动脉介入术后患者的抗血小板用药,对降低缺血心脏事件有帮助。

Objective To discuss the application value of thromboelastogram （TEG） in antiplatelet treatment in patients with coronary heart disease （CHD） and PCI. Methods The patients （n=90） were chosen and divided into stable angina pectoris group （SAP group）, unstable angina pectoris group （UAP group） and acute myocardial infarction group （AMI group, each n=30）. All patients were given detections of TEG and coagulation function test, and difference in TEG indexes, coagulation parameters and reactivity to antiplatelet treatment were compared among 3 groups. Results The levels of R, K, LY30, APTT, TT and INR decreased gradually, and levels of Angle, MA, CI, FIB and D-D increased gradually in all groups （all P〈0.01-P〈0.05）. The high coagulation images of TEG were 0.0%, 33.3%and 50.0%respectively in SAP group, UAP group and AMI group. The incidence of high coagulation image was significantly higher in AMI group than that in SAP group and UAP group （P〈0.05）. The incidence of ischemia cardiac events increased significantly in patients with normal reactivity to antiplatelet treatment （9.2%） than that in those with lower reactivity to antiplatelet treatment （20.0%） within 3 m （χ2=4.347, P〈0.05）. Conclusion The detection of TEG can guide the administration of antiplatelet drugs and reduce the incidence of ischemia cardiac events.