应用受试者曲线分析血栓弹力图在老年人群阿司匹林抵抗诊断中的价值

Role of thromboelastography in diagnosis of aspirin resistance in the elderly

目的应用ROC曲线评价血栓弹力图在诊断阿司匹林抵抗（AR）方面的价值。方法收集2008年4月~2010年7月驻京部队干休所服用阿司匹林（75~100mg/d,≥1个月）的老年患者471例。所有患者行光比浊法和血栓弹力图法检测血小板的功能。其光比浊法AR诊断标准为：花生四烯酸（AA）作诱导剂,血小板聚集率≥20%。结果采用AA诱导光比浊法,AR患者65例,发生率13.8%。以经典光比浊法为参照,通过ROC曲线发现,血栓弹力图法曲线下面积为0.794（0.755~0.830）。采用血栓弹力图法诊断AR,血小板聚集率临界点为56.2%,特异性为79.6%,敏感性为73.8%。无论是采用血小板聚集率≥56.2%,或传统的≥50%的临界点为血栓弹力图法诊断AR的标准,与AA诱导的光比浊法比较,在诊断AR方面,二者一致性较差（Kappa〈0.7）。结论血栓弹力图法在诊断AR方面,不完全与光比浊法诊断AR结果相符。因此,对血栓弹力图结果的解读需要谨慎。

Objective To assess the role of thromboelastography（TEG）in diagnosis of aspirin resistance（AR）according to its ROC curve.Methods Four hundred and seventy-one elderly patients in Beijing who administered aspirin（75-100 mg/d）≥ 1 month from April 2008 to July2010were included in this study.Their platelet function was tested by turbidimetry and TEG respectively.AR was diagnosed when arachidonic acid（AA）-induced platelet aggregation rate was≥20%.Results AR was diagnosed in 65patients（13.8%）by turbidimetry.TEG showed that the area under the ROC curve was 0.794（0.755-0.830）.The critical platelet aggregation rate was56.2%.The specificity and sensitivity of TEG for AR were 79.6% and 73.8% respectively.AR could thus be diagnosed by TEG whether the critical platelet aggregation rate was ≥56.2% or the traditional platelet aggregation rate was≥50%.The consistency was poor between TEG and turbidimetry in diagnosis of AR（Kappa0.7）.Conclusion TEG is not quite consistent with turbidimetry in diagnosis of AR.It should thus be careful to diagnose AR according to TEG.