LTA检测血小板聚集功能对抗血小板药物疗效的评价

Effect of platelet aggregation function tested by LTA on the efficacy of antiplatelet drugs

目的探讨光学比浊法(LTA)血小板聚集功能检测对抗血小板药物疗效的影响。方法 949例血栓性疾病患者,随机分为单独用药组(294例)、联合用药组(655例),选取同期体检健康者206例作为对照组;单独用药组根据敏感药物不同分为阿司匹林敏感组(190例)和氯吡格雷敏感组(104例),联合用药组根据用药不同分为阿司匹林+氯吡格雷用药组(321例)、阿司匹林+替格瑞洛用药组(303例)、阿司匹林+替格瑞洛+替罗非班用药组(31例)。比较对照组与单独用药组、对照组与联合用药组血小板聚集功能指标[花生四烯酸(AA)、胶原蛋白(COLL)、肾上腺素(EPN)、二磷酸腺苷(ADP)]。结果对照组ADP(84.1±7.3)%、EPN(84.7±9.0)%、COLL(85.0±8.0)%、AA(87.2±6.0)%均高于阿司匹林敏感组的(57.6±11.6)、(33.0±16.6)、(27.9±17.7)、(9.5±5.6)%和氯吡格雷敏感组的(60.5±14.0)、(56.1±22.5)、(49.0±23.4)、(39.0±32.7)%,且阿司匹林敏感组EPN、COLL、AA均低于氯吡格雷敏感组,差异均具有统计学意义(P<0.05)。阿司匹林敏感组和氯吡格雷敏感组ADP比较,差异无统计学意义(P>0.05)。阿司匹林+氯吡格雷用药组、阿司匹林+替格瑞洛用药组、阿司匹林+替格瑞洛+替罗非班用药组ADP、EPN、COLL、AA均低于对照组,差异均具有统计学意义(P<0.05)。阿司匹林+替格瑞洛用药组ADP、COLL均低于阿司匹林+氯吡格雷用药组,差异均具有统计学意义(P<0.05)。阿司匹林+替格瑞洛用药组与阿司匹林+氯吡格雷用药组EPN、AA比较,差异均无统计学意义(P>0.05)。而阿司匹林+替格瑞洛+替罗非班用药组ADP、EPN、COLL、AA均低于阿司匹林+替格瑞洛用药组与阿司匹林+氯吡格雷用药组,差异均具有统计学意义(P<0.05)。结论这四种诱导剂可以很好的聚集血小板,可以充分反映血小板的活性和抑制程度。从临床意义来说,这几种诱导剂可以很好的监测抗血小板药物疗效,对血栓性疾病的抗栓方案的选择和疗效的监测很有帮助。

Objective To discuss the effect of platelet aggregation function tested by light transmittance aggregometry(LTA) on the efficacy of antiplatelet drugs. Methods A total of 949 patients with thrombotic disease were randomly divided into single medication group(294 cases) and combined medication group(655 cases). Concurrent 206 healthy subjects were taken as the control group. Single medication group was divided into aspirin sensitive group(190 cases) and clopidogrel sensitive group(104 cases) according to different sensitive drugs. Combined medication group was divided into aspirin + clopidogrel group(321 cases), aspirin + ticagrelor group(303 cases), and aspirin + ticagrelor + tirofiban group(31 cases) according to the different medications. The platelet aggregation function indexes [arachidonic acid(AA), collagen(COLL), epinephrine(EPN), adenosine diphosphate(ADP)] were compared between the control group and single medication group, the control group and combined medication group. Results The ADP(84.1±7.3)%, EPN(84.7±9.0)t, COLL(85.0±8.0)% and AA(87.2±6.0)% of the control group were higher than those of aspirin sensitive group [(57.6±11.6),(33.0±16.6),(27.9±17.7) and(9.5±5.6)%] and clopidogrel sensitive group [(60.5±14.0),(56.1±22.5),(49.0±23.4) and(39.0±32.7)%];the EPN, COLL and AA of aspirin sensitive group were lower than those of clopidogrel sensitive group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in ADP between aspirin sensitive group and clopidogrel sensitive group(P>0.05). The ADP, EPN, COLL and AA of aspirin + clopidogrel group, aspirin + ticagrelor group, and aspirin + ticagrelor + tirofiban group were lower than those of the control group, and the difference was statistically significant(P<0.05). The ADP and COLL of aspirin + ticagrelor group were lower than those of aspirin + clopidogrel group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in EPN and AA between aspirin + ticagrelor group and aspirin + clopidogrel group(P>0.05). The ADP, EPN, COLL and AA of aspirin + ticagrelor + tirofiban group were lower than aspirin + ticagrelor group and aspirin + clopidogrel group, and the difference was statistically significant(P<0.05). Conclusion These four kinds of inducers can have a good aggregation effect on platelets, and fully reflect the activity of platelets and its inhibition degree. In clinical sense, these inducers can monitor the efficacy of antiplatelet drugs very well, and are very helpful to the selection of antithrombotic regimens and efficacy monitoring of thrombotic diseases.