应用血栓弹力图评价氯吡格雷血药浓度与凝血功能的相关性

Evaluation of the Correlation of Plasma Concentrations of Clopidogrel with Coagulation Function by Thrombelastography

目的:考察氯吡格雷血药浓度与凝血功能的相关性。方法:选择我院2014年6月-2015年6月经皮冠状动脉介入治疗术后的急性冠状动脉综合征患者126例,术前服用维持剂量(硫酸氢氯吡格雷75 mg+阿司匹林100 mg),qd,连续服用5 d;术前1 d顿服负荷剂量(硫酸氢氯吡格雷300 mg+阿司匹林100 mg);术后继续服用维持剂量。于术后服用维持剂量的第2日,采用液相色谱-串联质谱法测定患者体内氯吡格雷的血药浓度,采用血栓弹力图仪测定患者血凝块形成时间[第一块纤维蛋白凝块形成的时间(R)+血凝块强度达到20 mm振幅的时间(K)]、纤维蛋白和血凝块加固速度(以Angle表示)及纤维蛋白凝块最终强度(MA),采用Pearson检验进行相关性分析。结果:患者体内氯吡格雷的平均血药浓度为(82.3±20.1)ng/L,(R+K)为(7.8±2.4)min,Angle为(64.1±8.7)°,MA为(60.7±7.2)mm;氯吡格雷血药浓度与(R+K)呈正相关(r=0.671,P<0.01),与Angle呈负相关(r=-0.556,P<0.01),与MA不相关(r=-0.073,P>0.05)。结论:随着氯吡格雷血药浓度的升高,(R+K)延长,而纤维蛋白和血凝块加固速度降低。

OBJECTIVE：To investigate the correlation of plasma concentrations of clopidogrel with coagulation function.METHODS：126 acute coronary syndrome（ACS） patients underwent PCI were selected from our hospital during Jun. 2014-Jun.2015. They were given maintenance dose（clopidogrel hydrogen sulfate 75 mg＋aspirin 100 mg）before operation,qd,for consecutive 5 d;given loading dose（clopidogrel hydrogen sulfate 300 mg＋aspirin 100 mg）at a draught one day before operation;given maintenance dose again after operation. On the second day of giving maintenance dose after operation,plasma concentration of clopidogrel was determined by LC-MS/MS;thrombelastography（TEG）was used to determine blood clot formation time [the formation time of first piece fibrae sanguis（R）＋the time of blood clot strength reaching 20 mm（K）],fibrae sanguis and blood clot consolidation time（expressed by Angle） and fibrae sanguis and blood clot final strength（MA）. Pearson test was adopted for relationship analysis. RESULTS：Average plasma concentration of clopidogrel was（82.3±20.1）ng/L,（R＋K）was（7.8±2.4）min,Angle was（64.1±8.7）° and MA was（60.7±7.2）mm. Plasma concentration of clopidogrel was positively correlated with（R＋K）（r=0.671,P〈0.01）and negatively correlated with Angle（r=-0.556,P〈0.01）. There was no correlation between plasma concentration of clopidogrel and MA（r=-0.073,P〉0.05）. CONCLUSIONS：As plasma concentration of clopidogrel increased,blood clot formation time prolonged while fibrae sanguis and blood clot consolidation speed decreased.