血栓弹力图检测抗血小板药物疗效与下肢动脉腔内治疗后再缺血关系的研究

Thrombelastography in evaluating effect of antiplatelet drugs for patients undergoing peripheralendovascular treatment and relationship with ischemic-events-free duration

目的应用血栓弹力图（thromboelastography，TEG）评估下肢动脉硬化闭塞症腔内治疗后发生再缺血的患者抗血小板药物的疗效。方法回顾性分析本院2015年3月至2016年10月髂股动脉支架置入后再次出现缺血事件的38例患者的临床资料，应用TEG检测花生四烯酸途径（arachidonicacid，AA）的血小板抑制率、腺苷二磷酸途径（adenosinediphosphate，ADP）的血小板抑制率及腺苷二磷酸诱导的血小板一纤维蛋白凝块强度（ADP—inducedplatelet—fibrinclotstrength，MA），并分析MA〉47mnl和MAADP≤47mlTI两组间差异，以及TEG指标与初次治疗后无缺血事件维持时间的关联。结果9例患者（23．9％）AA抑制率〈50％，14例患者（36．8％）ADP抑制率〈30％，5例患者（13．2％）同时出现AA抑制率〈50％且ADP抑制率〈30％。ADP抑制率〈30％的患者与ADP抑制率≥30％的患者相比，初次治疗后无缺血事件维持时间明显少于后者（x2=10．755，P〈0．001）；在MA〉47mm的患者中，初次治疗后无缺血事件维持时间也明显少于MA≤47mm的患者（X2=4．408，P=0．036）。结论抗血小板药物反应低下是下肢腔内治疗后再缺血的重要危险因素，TEG检测能指导个体化抗血小板药物应用，减少治疗后缺血事件的发生。

Objective To evaluate the effect of antiplatelet drugs and ischemic-events-free duration by thromboelastography （TEG） in patients undergoing peripheral endovascular treatment. Methods From Mar 2015 to Oct 2016, 38 patients undergoing initial successful peripheral stenting and then coming back for recurrent ischemic events. TEG was used to evaluate the platelet inhibition rate induced by arachidonic acid （AA%） approach, the platelet inhibition rate induced by adenosine diphosphate （ADP%） approach, and the ADP-induced platelet-fibrin clot strength （ MAADP ）. Clinical feature differences between patients with MAADP 〉 47 mm and MAADP 〈 47 mm were compared. Results AA% less than 50% was found in 9 patients（23.9% ）, and ADP% less than 30% in 14 patients（36. 8% ）. 5 patients met the two conditions. Patients with MAADP 〉 47 mm had a significantly lower ADP% （22 = 10. 755, P 〈 0. 001 ） , compared to patients with MAADP 〈47 ram. Univariate survival analysis showed ADP% 〈 30% and MAADP 〉47 mm were risk factors for getting shorter ischemie-events-free duration, compared to patients with ADP% 〉30 （P 〈 0. 001 ） , with MAADe 〈47 mm （X2 = 4. 408, P = O. 036）. Conclusions TEG may detect those patients who has a low response to antiplatelet drugs, and some TEG parameters may have a ischemic predictive value.