血栓弹力图在川崎病儿童抗血小板治疗中的应用

Application of thrombelastography in antiplatelet therapy in children with Kawasaki disease

目的应用血栓弹力图（thrombelastography，TEG）评估川崎病患儿抗血小板药物治疗的效果。方法回顾性分析2016年5月至2016年12月收治的川崎病患儿的临床资料，采用血栓弹力图-血小板图（TEG-platelet maping，TEG-PM）检测花生四烯酸（arachidonic acid，AA）途径血小板抑制率（AA%）及二磷酸腺苷（adenosine diphosphate，ADP）途径血小板抑制率（ADP%），比较阿司匹林及双嘧达莫对血小板抑制效应的差异及不同TEG检测时间、阿司匹林用量对血小板抑制率的影响。结果阿司匹林及双嘧达莫对血小板的抑制作用存在明显个体差异。阿司匹林对血小板的抑制率[M（P25，P75）]62.45%（35.58%，90.95%）高于双嘧达莫对血小板的抑制率23.75%（11.60%，48.38%），差异具有统计学意义（P〈0.01）。川崎病患儿双嘧达莫抵抗的发生率（56.75%）高于阿司匹林抵抗的发生率（35.71%），差异具有统计学意义（P〈0.01）。川崎病患儿应用两种抗血小板药物的血小板抑制率存在线性相关（r＝0.351，P〈0.01）。阿司匹林及双嘧达莫用药4 d后，用药时间长短对血小板抑制率的影响差异无统计学意义，阿司匹林不同剂量对AA%的影响差异无统计学意义。结论TEG是一项可以有效评估川崎病患儿抗血小板药物疗效的手段。

ObjectiveTo evaluate the efficacy of antiplatelet agents in patients with Kawasaki disease （KD） by using thrombelastography （TEG）.MethodsA retrospective study of KD patients admitted in our hospital from May 2016 to December 2016 was conducted.Platelet inhibition rates of Arachidonic acid pathway（AA%） and Adenosine diphosphate pathway were assessed using TEG platelet mapping.The effects of aspirin and dipyridamole on platelet inhibition were compared, and the differences of platelet inhibition rates in different aspirin dose and duration of medication were determined.ResultsThere were significant individual differences in the inhibition of platelets by aspirin and dipyridamole.The inhibition rate of aspirin on platelets[M（P25, P75）] was 62.45% （35.58%, 90.95%）, which was higher than that of dipyridamole[23.75% （11.60%, 48.38%）], there was significant difference （P〈0.01）. The incidence of dipyridamole resistance in children with KD （56.75%） was higher than that in patients with resistance to aspirin （35.71%）, and there was significant difference （P〈0.01）. There was a linear correlation between platelet inhibition rates of two antiplatelet agents in children with KD （r=0.351, P〈0.01）. There was no significant difference in the effect of aspirin and dipyridamole on platelet inhibition rate after 4 days of administration.There was no significant difference in the effect of different doses of aspirin on AA%.ConclusionTEG is an effective way to evaluate the efficacy of antiplatelet therapy in children with KD.