血栓弹力图法和光学比浊法监测PCI术后氯吡格雷疗效的对比研究

Comparatively Study on the Thromboelastography and Light Transmission Aggregometry for Platelet Aggregation in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention under Antiplatelet Therapy

目的探讨光学比浊法(LTA)和血栓弹力图法(TEG)检测氯吡格雷抵抗(CPGR)的疗效。方法收集2015年1~11月心内科经双联抗血小板治疗并行冠状动脉介入(PCI)后的急性冠状动脉综合征(ACS)患者425例,对ADP诱导的光学比浊法血小板聚集率(LTAADP)与血栓弹力图法ADP诱导的血小板抑制率(TEGADP)检测氯吡格雷抵抗(CPGR)进行一致性和相关性分析,结合CYP2C19基因表达的酶活性程度,分析其与LTA和TEG法检测CPGR的关系。结果 LTA和TEG法所测血小板聚集率检测CPGR分别为12.0%和11.8%,两者存在负相关(r=-0.351,P<0.01);CYP2C19基因酶活性程度与LTA法检测CPGR存在一定的等级相关(r=0.239,P<0.01),与TEG法检测CPGR的关联无统计学意义(r=-0.088,P=0.70),且在两法检测CPGR上的差异无统计学意义。结论 TGE与LTA法在监测氯吡格雷疗效上有很好的一致性,CYP2C19基因酶活性程度与这两种方法检测CPGR的差异无统计学意义。

Objective The dual antiplatelet drug for the treatment of percutaneous coronary intervention after operation of acute coronary syndrome patients,the by optical than Light Transmission Aggregometry （LTA） and Method of thromboelastography（TEG） detection of clopidogrel resistance（CPGR） consistency analysis,and compare the correlation with the levels of CYP2C19 enzyme activity. Methods A total of 425 patients with acute coronary syndrome treated with dual antiplatelet therapy and PCI in the Department of Cardiology during the period of January 2015 to November were collected. Consistency and correlation analysis of CPGR induced platelet aggregation rate （LTAADP） and ADP induced platelet inhibition rate （TEGADP） as well as the relationship between the two Methods to detect CPGR and CYP2C19 gene expression level were done. Results The platelet aggregation rate measured by the LTA Method was used to detect the CPGR as 12%. The platelet inhibition rate measured by the TEG Method was used to detect the CPGR as 11.8%. There is a negative correlation between LTAADP and TEGADP （r=-0.351,P〈0.01）; There was a certain degree of correlation between the activity of CYP2C19 gene and the detection of CPGR by LTA Method （r=0.239,P=0.00）. No correlation between the degree of activity of CYP2C19 gene and the detection of CPGR by TEG Method （r=-0.088,P=0.70）. And no significant difference between the two Methods in the detection of CPGR was found. Conclusion TGE Method and LTA Method to monitor the efficacy of clopidogrel has well consistency,There was no significant difference between the two Methods for the detection of CPGR with the degree of CYP2C19 gene activity.