血栓弹力图评价抗血小板治疗的疗效及相关因素分析

Application of thrombelastography in assessing the effect of antiplatelet therapy and analysis of its related factors

目的用血栓弹力图(TEG)的方法评价抗血小板治疗的疗效和相关因素分析。方法选择自愿完成TEG测定的年龄≥60岁军队老年男性955例,按服用抗血小板药物分4组,阿司匹林组368例,氯吡格雷组115例,双联抗血小板药物组(双抗组)43例,无抗血小板药物组429例。用TEG指标评价抗血小板药物的有效性,并用多因素logistics回归分析影响疗效的相关因素。结果阿司匹林组花生四烯酸(AA)途径血小板抑制率(AA抑制率)为(48.0±19.3)%,氯吡格雷组二磷酸腺苷(ADP)途径血小板抑制率(ADP抑制率)为(63.0±18.2)%,双抗组AA抑制率为(51.0±16.5)%,ADP抑制率为(46.0±15.3)%,均在起效范围内。AA途径中,阿司匹林组与双抗组有效率无差异(45.80%vs 51.16%,P>0.05),ADP途径中,氯吡格雷组与双抗组有效率无差异(76.52%vs67.44%,P>0.05)。多因素logistics分析示,白细胞计数(OR=0.891,P=0.001),肾小球滤过率(OR=1.016,P=0.013)是增加出血的危险因素;血小板计数(OR=1.026,P=0.000),糖化血红蛋白(OR=1.358,P=0.011)是血栓风险增加的危险因素。结论严格质量控制的TEG测定可以作为临床抗血小板治疗疗效的评估手段之一。

Objective To assess the application of thrombelastography（TEG）in assessing the effect of antiplatelet therapy and analyze its related factors.Methods Nine hundred and fifty-five retired male officer aged ≥60years admitted to our hospital for TEG from June 2015 to August2015were divided into aspirin treatment group（n=368）,clopidogrel treatment group（n=115）,double antiplatelet drug treatment group（n=43）,and non-antiplatelet drug treatment group（n=429）according to the antiplatelet drugs they used.The effect of antiplatelet drugs was assessed by TEG.The related factors influencing the effect of antiplatelet therapy were analyzed by multivariate logistic regression analysis.Results The inhibition rate of platelets in AA pathway and ADP pathway was 48%±19.3%in aspirin treatment group,63.0%±18.2%in clopidogrel treatment group,51.0% ±16.5% and 46.0% ±15.3% respectively in double antiplatelet drug treatment group.No significant difference was found in the inhibition rate of platelets in AA pathway and ADP pathway in aspirin treatment group and clopidogrel treatment group（45.80% vs 51.16%,76.52%vs 67.44%,P〉0.05）.Multivariate logistic regression analysis showed that the number of WBC and eGFR were the risk factors for bleeding（OR=0.891,P=0.001;OR=1.016,P=0.013）.The number of platelets and HbA1 cwere the risk factors for thrombosis（OR=1.026,P=0.000;OR=1.358,P=0.011）.Conclusion TEG is one of the effective means in assessing the effect of antiplatelet therapy in clinical practice.