血栓弹力图法与光学比浊法评价急性冠状动脉综合征患者氯吡格雷反应性的临床研究

A comparison of thromboelastogram and light transmission aggregometry in detecting antiplatelet function of clopidogrel in patients with acute coronary syndrome

目的获得急性冠状动脉综合征（ACS）患者氯吡格雷用药后血小板高反应性（HPR）发生率,比较血栓弹力图（TEG）和光学比浊法（LTA）检测血小板聚集功能的相关性。方法连续入选141例年龄≤80岁的ACS患者,服用氯吡格雷≥3 d后,采用TEG法和LTA法同时检测腺苷二磷酸（ADP）诱导的血小板聚集功能,将TEG法检测出的氯吡格雷抑制率〈30%或LTA法检测出最大血小板聚集率MPAR≥46%定义为HPR,比较两种方法检测结果的相关性。所有患者随访1个月,比较两种方法检测出的血小板反应预测临床不良事件的敏感性。结果采用TEG法检测出HPR患者49例（34.8%,49/141）,LTA法检测出HPR 83例（58.9%,83/141）,两者间比较,差异有统计学意义（χ^2=16.464,P=0.000）。TEG法检测出的HPR患者总临床缺血事件发生率（10.2%,5/49）有高于同法检测的非HPR患者（5.4%,5/92）的趋势,但两者间比较差异无统计学意义（OR 1.98,95%CI0.54-7.20,P=0.480）。LTA法检测出的HPR患者总临床缺血事件发生率6.0%（5/83）,与非HPR患者8.6%（5/58）比较,差异无统计学意义（OR 0.68,95%CI 0.19-2.50,P=0.797）。结论 TEG法和LTA法检测ACS患者氯吡格雷反应性相关性较差,HPR检出率有显著差异。TEG法检测出的HPR患者出院后1个月的临床缺血事件发生率有高于非HPR患者的趋势。

Objective To obtain the incidence of high platelet reaction（ HPR） in ACS patients treated with clopidogrel and to analyse the correlation between the testing results of thromboelastogram（ TEG） and light transmission aggregometry（ LTA）. Methods A total of 141 ACS patients（ all age≤80years old） who had taken clopidogrel at least for 3 days were enrolled in the study. All patients were given platelet function detection by means of TEG and LTA. High on-treatment platelet reactivity（ HPR） was defined as 5 μmol / L ADP induced maximal platelet aggregation（ MPAR） ≥46% in LTA and 2 μmol / L induced clopidogrel inhibition ratio 〈30% in TEG. Compare the correlation between results of the two assays and the sensitivity of HPRs measured by the two different assays in predicting adverse clinical events according to 1-month followed-up results. Results HPR was found in 49（ 34. 8%） patients by TEG and in83（ 58. 8%） patients by LTA and the difference between the two HPR ratio was significant（ χ^2= 16. 464,P= 0. 000）. The incidence of clinical ischemic events in TEG-HPR group was higher than that in non TEGHPR group（ 10. 2% vs. 5. 4%,OR 1. 98,95% CI 0. 54-7. 20,P = 0. 480）,but the difference was not significant（ P〉 0. 05）. There was no significant difference in the incidence of clinical ischemic events between LTA-HPR group and non LTA-HPR group（ 6. 0% vs. 8. 6%,OR 0. 68,95% CI 0. 19-2. 50,P =0. 797）. Conclusions The correlation between the testing results of TEG and LTA in ACS patients treated with clopidogrel was poor,HPR ratios detected by two assays were significantly different. The occurrence tendency of clinical ischemic events in TEG-HPR group was higher than that in non TEG-HPR group.