氯吡格雷血小板反应性对经皮冠脉介入术后患者出血及缺血风险的评估效果

Evaluated effect of Clopidogrel platelet reactivity on the risk of bleeding and ischemia in patients after percutaneous coronary intervention

目的探讨氯吡格雷血小板反应性对经皮冠脉介入术(PCI)后患者出血及缺血事件的评估效果。方法选取2017年1月~2018年1月沧州市中心医院收治的306例经PCI置入药物洗脱支架且术后48 h内进行了氯吡格雷血小板反应性测定的患者作为研究对象,所有患者平均氯吡格雷血小板反应性的值为(31.2±12.9)%。所有患者在术前及术后均服用阿司匹林和氯吡格雷。收集患者的基线资料及1年出血及缺血事件发生情况。结果 1年内,共35例(11.4%)患者发生出血事件,23例(7.5%)患者出现缺血事件。氯吡格雷血小板反应性对出血事件评价的受试者工作特征曲线下面积(AUROC)为0.88,敏感度和特异度分别为74.3%和89.3%,切点值为≤15.0%。氯吡格雷血小板反应性对缺血事件评价的AUROC为0.74,敏感度和特异度分别为73.9%和77.0%,切点值为>43.7%。氯吡格雷血小板反应性在≤15.0%、>15.0%~43.7%、>43.7%这三个区间内发生出血及缺血事件的人数分别为26和1例、9和5例、17和0例。结论氯吡格雷血小板反应性对PCI后1年出血及缺血事件具有较好的评价效果,尤其是出血事件。但其治疗窗需要更进一步的研究来证实,从而为制定更加个性化的抗栓治疗策略提供依据。

Objective To investigate evaluated effect of Clopidogrel platelet reactivity on the risk of bleeding and ischemia events after percutaneous coronary intervention(PCI).Methods A total of 306 patients admitted to Cangzhou Central Hospital from January 2017 to January 2018 who had undergone PCI with drug-eluting stents and had undergone Clopidogrel platelet reactivity measurement within 48 hours after surgery were selected as the study subjects.The mean value of Clopidogrel platelet reactivity was(31.2±12.9)%.Aspirin and Clopidogrel before and after surgery were taken.Baseline information and the occurrence of bleeding and ischemia events were collected within 1 year.Results Within 1 year,bleeding events merged in 35 patients(11.4%),with ischemia events in 23 patients(7.5%).The area under the receiver operating characteristic curve(AUROC)of Clopidogrel platelet reactivity for bleeding events was 0.88,sensitivity and specificity were 74.3%and 89.3%,respectively,and the cut-off value was≤15.0%.The AUROC of Clopidogrel platelet reactivity for ischemic events was 0.74,sensitivity and specificity were 73.9%and 77.0%,respectively,and the cut-off value was>43.7%.The number of Clopidogrel platelet reactivity in the three intervals≤15.0%,>15.0%-43.7%,>43.7%occurring bleeding and ischemic events was 26 and 1,9 and 5,17 and 0,respectively.Conclusion Clopidogrel platelet reactivity presents good evaluated performance for bleeding and ischemic events in 1 year after PCI,especially for bleeding events.However,its therapeutic window needs to be further verifyed,so as to provide evidence for more individualized antithrombotic strategies.