血栓弹力图指导脑卒中二级预防临床研究

Clinical study of the application of TEG in secondary prevention for patients with cerebral ischemic stroke according to thromboelastography

目的应用血栓弹力图(thrombelastography,TGE)监测缺血性脑卒中(cerebral ischemic stroke)患者阿司匹林和氯吡格雷用药过程中花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率的变化情况并进行指导用药,探讨其在脑卒中的监测和二级预防价值。方法将我院80例确诊为缺血性脑卒中患者根据用药分为阿司匹林组(36例)和氯吡格雷组(44例),通过TEG-5000监测患者在治疗14 d后血小板抑制率变化确定出药物抵抗患者,对产生药物抵抗的患者改服另一类型药物(阿司匹林或氯吡格雷)后在7 d后再次使用TEG监测血小板抑制率。结果前期确定为阿司匹林抵抗型或氯吡格雷抵抗型患者在改服用另一药后,AA和ADP途径诱导的血小板抑制率相比之前都有极显著性的提高(P<0.01),具有统计学意义,说明TEG检测指导用药效果显著。另外,在两组药物抵抗组中的女性患者改服另一药物后用药效果显著优于男性患者,原因可能是更多男性脑卒中患者有高血压史、吸烟史和饮酒史等危险因素。结论 TEG技术能快速、准确地检测脑卒中患者服用阿司匹林及氯吡格雷后的血小板抑制率(AA%或ADP%),评估患者对不同抗血小板药物的反应性,从而为进一步制定个体化抗血小板治疗策略、指导脑卒中二级预防提供有效手段。

Objective To study the application of thromboelastography（TEG） in monitoring the platelet inhibition rate induced by the arachidonic acid（AA） or adenosine diphosphate（ADP） in patients with cerebral ischemic stroke after taking aspirin or clopidogrel,and guide the drugs usage. To evaluate the value of monitoring and secondary prevention in patients with cerebral ischemic stroke. Methods 80 patients with cerebral ischemic stroke were divided into aspirin group（36） and clopidogrel group（44） depending on medication. Patients with resistance to one drug were identified by applying TEG-5000 14 days after treatment and given other drug（aspirin or clopidogrel）; their platelet inhibition rates were determined with TEG 7 days after treatment of the new drug. Results After taking another drug（aspirin or clopidogrel）,the platelet inhibition rates（AA% or ADP%） of patients with cerebral ischemic stroke who were earlier identified as aspirin or clopidogrel resistant increased significantly（P〈0.01）,demonstrating TEG detection＇s remarkable guidance effect. In addition,the drug effects on female patients in two drug resistance groups were significantly better than those on male patients after taking another medicine, which can be attributed to more male cerebral apoplexy patients have histories of high blood pressure, smoking and drinking. Conclusion TEG can detect the platelet inhibition rate（AA% or ADP%） after taking aspirin or clopidogrel in patients with cerebral ischemic stroke quickly and accurately; it can also evaluate patients＇ responsiveness to different antiplatelet drugs. Hence it can be an effective method for secondary prevention of cerebral ischemic stroke and further development of individualized antiplatelet therapy strategy.