血栓弹力图在糖尿病肾病维持性血液透析患者抗血小板药物反应性中的评估价值

The value of thromboelastography for the antiplatelet drug reactivity in patients with diabetic nephropathy undergoing maintenance hemodialysis

目的探讨血栓弹力图(TEG)在糖尿病肾病(DN)维持性血透患者行经皮冠状动脉介入治疗(PCI)后抗血小板药物效果的评估价值。方法纳入2013年5月~2016年3月于浙江省人民医院就诊,行PCI术后1年内接受阿司匹林联合氯吡格雷双抗治疗的维持性血透患者46例。按照是否为DN所致终末期肾病而开始维持性血透分为DN组(20例)及NDN组(26例),进行TEG检测。血栓最大幅度(MA)、花生四烯酸(AA)途径抑制率、二磷酸腺苷(ADP)受体抑制率评估药物抵抗及分析临床意义。结果DN组MA值高于NDN组,差异有统计学意义(P<0.05)。DN组双联血小板聚集抵抗率高于NDN组,差异有统计学意义(P<0.05)。两组患者发生阿司匹林抵抗率、氯吡格雷抵抗率比较,差异无统计学意义(P>0.05)。结论与NDN患者比较,DN患者具有更高的PCI术后血栓风险。DN及NDN患者均存在对双联抗血小板药物抵抗,DN患者为甚,提示在此类高危患者可能需要常规进行血小板功能检测以指导调整药物。

Objective To explore the value of thromboelastography(TEG)in evaluating the effect of antiplatelet drugs after percutaneous coronary intervention(PCI)in patients with diabetic nephropathy(DN)maintenance hemodialysis.Methods A total of 46 patients with maintenance hemodialysis who were treated at the People′s Hospital of Zhejiang Province from May 2013 to March 2016 and received aspirin combined with clopidogrel within 1 year after PCI were included.According to whether end-stage renal disease caused by DN started maintenance hemodialysis,all patients were divided into DN group(20 cases)and NDN group(26 cases),and TEG test was performed.The maximum thrombus(MA),arachidonic acid(AA)pathway inhibition rate,and adenosine diphosphate(ADP)receptor inhibition rate were used to evaluate drug resistance and analyze clinical significance.Results The MA value in DN group was higher than that in group B,and the difference was statistically significant(P<0.05).The resistance rate of double platelet aggregation in DN group was higher than that in NDN group,and the difference was statistically significant(P<0.05).There were no significant differences in the aspirin resistance rate and clopidogrel resistance rate between the two groups of patients(P<0.05).Conclusion Patients with DN have a higher risk of thrombosis after PCI compared with NDN patient.Both DN and NDN patients have resistance to dual antiplatelet drugs,and patients with DN are very resistant,suggesting that platelet function to guide the adjustment of the drug may be required in such high-risk patients.