血小板功能系列检测对接受复杂经皮冠状动脉介入治疗患者临床结局的预测价值

Predictive value of serial platelet function testing on outcome in patients undergoing complex percutaneous coronary intervention

目的 评价血小板功能检测（PFT）对复杂经皮冠状动脉介入（PCI）术后患者临床结局的预测价值.方法 回顾性分析2011年10月至2012年6月于北京安贞医院接受复杂PCI治疗的602例冠心病患者,分别在PCI术后的第1、6和12个月使用透光率比浊法检测血小板功能,并计算其平均值,治疗期间高血小板活性（HTPR）定义为二磷酸腺苷（ADP）诱导的平均血小板聚集度≥40％.受试者根据平均ADP聚集度分为HTPR组（ADP≥40％）和非HTPR组（ADP＜ 40％）,并进一步将HTPR组患者分为标准双联抗血小板治疗（DAPT）及延长DAPT亚组.随访观察患者主要不良心脑血管事件（MACCE）发生率.采用Kaplan-Meier分析比较两组间MACCE发生率,使用Cox比例风险模型分析发生MACCE的影响因素.结果 共565例患者完成了随访,随访时间为（28.47 ±7.45）个月,HTPR组患者285例,非HTPR组患者280例.随访期间共发生33例MACCE,其中HTPR组29例（8.42％）,非HTPR组9例（3.21％）.Kaplan-Meier分析显示HTPR组患者的MACCE发生率明显高于非HTPR组（log-rank检验,P=0.01）.Cox多因素分析显示,HTPR是接受复杂PCI治疗的冠心病患者发生MACCE的独立危险因素（HR=2.69,95％CI 1.23 ～ 5.85,P=0.01）.PCI术后不同时间DAPT亚组间MACCE发生率差异无统计学意义（P＞0.05）.结论 PFT系列检测能够预测复杂PCI术后患者的临床结局.

Objective To observe the predictive value of serial platelet function testing （PFT） on outcome in patients undergoing complex percutaneous coronary intervention （PCI）.Methods Six hundred and two consecutive patients undergoing complex PCI in Anzhen hospital were enrolled during October 2011 to June 2012.Adenosine diphosphate （ADP）-induced platelet aggregation was measured by light transmission aggregometry on the first,sixth and twelfth month after PCI and the mean value was calculated.The cut-off value of high on-treatment platelet reactivity （HTPR） was defined as 40％.The primary endpoint was major adverse cardiovascular and cerebral event （MACCE）.Clinical outcomes were analyzed by the Kaplan-Meier method and differences were compared using the log-rank test.Multivariate analyses by Cox proportion hazards regression were applied to identify variables independently associated with the adverse outcomes.Results Five hundred and eighty-five patients （HTPR,n =285;non-HTPR,n =280） finished the follow-up （（28.47 ± 7.45） months）.A total of 33 cases of MACCE were observed during the follow-up,among which 29 cases （8.42％） were in HTPR group and 9 cases （3.21％） in the non-HTPR group.Kaplan-Meier analysis suggested that HTPR was associated with an increased incidence of MACCE （log-rank test,P =0.01）.The Cox muhivariate analysis indicated that HTPR was an independent risk factor of MACCE （HR =2.69,95％ CI 1.23-5.85,P =0.01） in patients undergoing complex PCI.Incidence of MACCE was similar between HTRP patients receiving standard dual antiplatelet therapy （DAPT） or prolonged DAPT （＞ 12 months）.Conclusion Serial PFT could predict the long-term prognosis of patients underwent complex PCI.