光学比浊法与血栓弹力图法评价氯吡格雷疗效的一致性研究及氯吡格雷抵抗相关风险因素分析

Study on the consistency of thromboelastography and light transmission aggregometry in monitoring clopidogrel efficacy and the risk factors of clopidogrel resistance

目的以血栓弹力图法(TEG)为比对方法,研究光学比浊法(LTA)检测血小板聚集率在氯吡格雷疗效评价方面的作用,观察二者是否具有良好的一致性,并根据LTA检测结果,对影响氯吡格雷疗效的可能风险因素进行评估。方法收集2018年11月至2019年5月于北京天坛医院就诊的患者67例,均服用氯吡格雷(波立维)抗血小板药物治疗,分别采用TEG及LTA检测血小板功能,评价两种方法的一致性,并对相关参数进行相关分析。根据LTA检测结果将患者划分为氯吡格雷抵抗组和氯吡格雷非抵抗组,比较两组患者的临床资料及实验室指标,并采用Logistic回归分析氯吡格雷抵抗可能的风险因素。结果LTA及TEG在评价血小板功能方面具有良好的一致性(P>0.05),且LTA检测的由ADP诱导的血小板最大聚集率(PAg-ADP%)与TEG检测的血小板聚集抑制率(ADP%)存在直线相关关系(r=-0.493,P=0.000)。与氯吡格雷非抵抗组比较,氯吡格雷抵抗患者年龄更大,平均血小板体积(MPV)较大,差异有统计学意义(P<0.05)。多元Logistic回归分析显示年龄(OR=1.106,95%CI 1.038~1.178,P=0.002)、MPV(OR=1.968,95%CI 1.079~3.588,P=0.027)构成氯吡格雷抵抗的独立风险因素。结论LTA可作为早期评价氯吡格雷疗效的有效可靠的检测方法。高龄、高水平MPV构成氯吡格雷抵抗的独立风险因素。

Objective To use thromboelastography(TEG)as comparison method,the effect of light transmission aggregometry(LTA)on the efficacy evaluation of clopidogrel is studied,and the consistency of the two methods is observed.The possible risk factors affecting the efficacy of clopidogrel were evaluated according to the results of LTA.Methods 67 patients taking antiplatelet drugs from Beijing Tiantan Hospital were enrolled from November 2018 to May 2019.Platelet function was measured using TEG and LTA.Correlation analysis were performed on related parameters.Patients were classified as clopidogrel resistant and non-resistant according to LTA results.The clinical and laboratory data of the two groups were compared.Risk factors related to clopidogrel resistance were analyzed using Logistic regression analysis.Results TEG and LTA were consistent in evaluating platelet function(P>0.05),and ADP-induced platelet aggregation(PAg-ADP%)and TEG platelet aggregation inhibition rate(ADP%)had linear correlation(r=-0.493,P=0.000).Compared with the non-resistance group,the mean age of clopidogrel resistant patients was larger and the mean platelet volume(MPV)was larger,the difference was statistically significant(P<0.05).The Logistic regression analysis showed the age(OR=1.106,95%CI 1.038-1.178,P=0.002)and MPV(OR=1.968,95%CI 1.079-3.588,P=0.027)were the independent risk factors of clopidogrel resistance.Conclusion LTA can be used as an effective and reliable test for evaluating the efficacy of clopidogrel at an early stage.Advanced age and high levels of MPV constitute independent risk factors for clopidogrel resistance.