电阻抗法在急性冠脉综合征患者中的应用

Application of the Impedance Platelet Aggregometry in Patients with Acute Coronary Syndrome

目的:探讨电阻抗法测定血小板聚集功能在冠心病患者中的应用。方法:通过电阻抗法对486名急性冠脉综合征的患者检测,所有患者分别于服药前和服药后第4天抽取肘静脉血,采血后1小时内用全血阻抗法测定三磷酸腺苷(ADP)和花生四烯酸(AA)诱导的血小板聚集率;其中50例患者出现氯吡格雷抵抗,28例患者出现阿司匹林抵抗。结果:通过电阻抗法测定的抗血小板药物抵抗的发生率(10.29%)与文献报道的一致;在原来抗血小板药物基础增加西洛他唑或者增加氯吡格雷的剂量都能明显改善血小板药物抵抗,随着服药时间的增加血小板药物抵抗呈下降趋势;大剂量氯吡格雷组相比西洛他唑组在改善氯吡格雷抵抗更明显,差异有统计学意义(P<0.05)。结论:电阻抗法测定血小板聚集功能方便快捷、安全可靠,更方便指导临床用药。

Objective： To explore the application value of impedance platelet aggregometry in the determination of the platelet aggregation function in patients with coronary heart disease（CHD）. Methods： 486 patients with acute coronary syndrome were enrolled and the platelet aggregation function was detected by impedance platelet aggregometry determination. All the patients were extracted thrhough elbow venous before taking medication and 4 days later,using whole blood impedance method to detect platelet aggregation rate through adenosine triphosphate（ADP） and arachidonic acid（AA）within 1 hour. Among these, there were 50 patients who had Clopidogrel resistance, and 28 patients who had Aspirin resistance. Results： With the increase of dose, Cilostazol or Clopidogrel can obviously improve the resistance of the antiplatelet drug on the basis of the original antiplatelet drugs; with the prolongation of taking medicine, the resistance of antiplatelet drug was on the decline; compared with the Cilostazol group, the clopidogrel group of high dose was more obvious in improving clopidogrel resistance, and the difference was statistically significant（P〈0.05）. Conclusions： Impedance Platelet Aggregometry is quick, safe and reliable to detect platelet aggregation rate, and it is convenient to guide the clinical medication.