血栓弹力图评价冠心病患者抗血小板药物治疗的临床疗效

Evaluation on results of antiplatelet drugs in coronary heart disease patients by Thrombelastogram

目的用血栓弹力图(TEG)评估冠心病患者正规服用阿司匹林及氯吡格雷后血小板抑制率的改变及临床疗效。方法将120例冠心病住院患者分成阿司匹林组(Ⅰ组)、氯吡格雷组(Ⅱ组)、阿司匹林+氯吡格雷组(Ⅲ组),使用血栓弹力图仪检测抗血小板药物治疗后花生四烯酸(AA)通路和二磷酸腺苷(ADP)受体途径诱导的血小板抑制率。结果 120例患者中,Ⅰ组AA诱导的血小板抑制率平均值为(76.49±18.99)%,Ⅱ组ADP受体途径诱导的血小板抑制率平均值为(54.32±16.18)%,Ⅲ组AA和ADP诱导的血小板抑制率分别为(80.52±14.40)%和(54.81±9.13)%,Ⅰ组与Ⅱ组相比,两种药物单独使用对血小板抑制率的影响差异有统计学意义(t=5.665,P<0.01),其中Ⅰ组对阿司匹林有效者(血小板抑制率≥50%)为33例(82.5%),Ⅱ组对氯吡格雷有效者(血小板抑制率≥30%)为32例(80%),Ⅲ组对阿司匹林或氯吡格雷有效者为39例(97.5%),阿司匹林与氯吡格雷联用组(Ⅲ组)疗效较好(χ2=6.202,P<0.05)。结论常规剂量100 mg/d阿司匹林抗血小板作用优于常规剂量75 mg/d氯吡格雷,阿司匹林与氯吡格雷联合应用能弥补单用阿司匹林或氯吡格雷发生抵抗时对血小板抑制率的作用,从而提高临床疗效,使血小板抑制率达标。TEG在冠心病患者的抗血小板药物治疗方案选择上有指导意义。

Objective To determine inhibitory effects of different forms of antiplatelet agents,thromboelas-torraph（TEG）was used to assess the inhibitory rates of adenosine diphosphate（ADP）receptors and arachidonic acid （AA）pathway in platelets.Methods 120 coronary heart disease（CHD）patients were divided into three groups：As-pirin（group I）,Clopidogrel（group Ⅱ）and Aspirin ＋Clopidogrel（group Ⅲ）.The inhibitory rates of AA and ADP re-ceptor pathway in platelets were detected by TEG and analyzed with SPSS version 16.0.Results Platelet inhibition in response to aspirin was（76.49 ±18.99）% in group I,and（80.52 ±14.40）% in group Ⅲ.Platelet inhibition in response to clopidogrel was（54.32 ±16.18）% in group Ⅱ,and（54.81 ±9.13）% in group Ⅲ.Among them,effec-tive for aspirin were 33 in group I,effective for clopidogrel were 32 in group Ⅱ and effective for aspirin or clopidogrel were 39 in group Ⅲ.The difference of therapeutic efficacy between group I and group Ⅱ was significant（t =5.665,P〈0.01）.The clinical effect of group Ⅲ was better（χ2 =6.202,P〈0.05）.Conclusions The antiplatelet effect of daily 100mg of aspirin is better than 75mg of clopidogrel.The combination of aspirin and clopidogrel can make up for the role of platelet inhibition rate when the occurrence of aspirin or clopidogrel resistance,and improve the clinical effect.TEG plays a guiding role in the antiplatelet drug treatment of CHD patients.