血栓弹力图对CABG后抗血小板治疗远期缺血事件的指导价值

The value of thromboelastography in assessing the ischemic events due to post-CABG antiplatelet therapy

目的:探讨血栓弹力图(TEG)指标对冠状动脉旁路移植术(CABG)后抗血小板治疗远期发生缺血事件的预测价值。方法:选择行CABG并符合纳入标准的患者90例,术后阿司匹林和氯吡格雷双联抗血小板治疗且行血栓弹力图检测,电话随访1年,记录患者是否发生缺血事件。结果:血块强度MAthrombin[OR=1.123,95%CI:(1.014,1.244),P<0.05]、BMI[OR=1.234,95%CI:(1.002,1.518),P<0.05]与远期缺血事件发生呈正相关,MAthrombin=66.40mm[ROC曲线下面积0.663,95%CI:(0.536,0.790),灵敏度为0.789,特异度为0.521)]、BMI=24.60[ROC曲线下的面积0.642,95%CI:(0.500,0.784),灵敏度为0.632,特异度为0.676]是诊断界值。结论:MAthrombin>66.40mm可考虑作为接受CABG后抗血小板治疗患者的缺血事件发生的预测界值,应控制BMI≤24.60以减少远期发生缺血事件的可能性。

Objective：To explore the value of thromboelastography（TEG）in diagnosing ischemic events following post-coronary artery bypass grafting（CABG）anti-platelet therapy.Method：Ninety patients underwent CABG were treated with aspirin enteric-coated tablets and clopidogrel tablets double antiplatelet in combination with TEG detection.All patients were followed up for one year and ischemic events were recorded by telephone.Result：MAthrombin[OR=1.123,95%CI：（1.014,1.244）,P〈0.05]and BMI[OR=1.234,95%CI：（1.002,1.518）,P〈0.05]were positively associated with the occurrence of long-term ischemic events.ROC curve analysis showed that MAthrombin=66.40 mm [The area under the ROC curve was 0.663,95%CI：（0.536,0.790）,the sensitivity was 0.789,the specificity was 0.521],BMI=24.60 [The area under the ROC curve was 0.642,95%CI：（0.500,0.784）,the sensitivity was 0.632,the specificity was 0.676]were the diagnostic threshold.Conclusion：MAthrombin can be used to select those patients who are more susceptible to have post-CABG ischemic events and 66.40 mm can be used as a diagnostic cut point.BMI is also a risk factor for ischemic and hemorrhagic events.To decrease the risk for adverse events,the goal of BMI control should be no higher than 24.60 kg/m^2.