血小板聚集率指导的抗血小板药治疗对急性冠脉综合征患者经皮冠状动脉介入治疗术后近期和远期预后的影响

Effects of Antiplatelet Drugs Therapy Guided by Platelet Aggregation Rate on the Short-Term and Long-Term Prognosis in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

目的:探讨血小板聚集率指导的抗血小板药治疗对急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后近期和远期预后的影响。方法:将2018年1月至2019年8月唐山市协和医院收治的92例拟行PCI术的ACS患者随机分为指导组和常规组,每组46例。指导组患者术后在血小板聚集率指导下给予氯吡格雷等抗血小板药治疗,常规组患者给予常规剂量抗血小板药治疗,均持续治疗1年。观察患者治疗前(T_(0))、治疗后1个月(T_(1))和治疗后12个月(T_(2))的血栓弹力图指标[凝血反应时间(R)、凝固时间(K)和血栓最大幅度(MA)]、血小板参数[血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)和血小板分布宽度(PDW)]变化,记录T_(1)、T_(2)时主要不良心血管事件(major adverse cardiovascular events,MACE)和出血并发症的发生情况。结果:与T_(0)时比较,T_(1)和T_(2)时两组患者的R、K均显著延长,MA显著降低;T_(1)时,指导组患者的R、K均显著长于常规组,MA显著低于常规组,差异均有统计学意义(P<0.05)。与T_(0)时比较,T_(1)和T_(2)时两组患者的PLT、MPV、PCT及PDW均显著降低;T I时,指导组患者的PLT、MPV、PCT及PDW均显著低于常规组,差异均有统计学意义(P<0.05)。T_(1)时,指导组患者的MACE发生率显著低于常规组,差异有统计学意义(P<0.05);T_(2)时,两组患者MACE发生率的差异无统计学意义(P>0.05)。T_(1)和T_(2)时,两组患者出血发生率的差异均无统计学意义(P>0.05)。结论:血小板聚集率指导的抗血小板药治疗能够明显降低ACS患者PCI术后近期MACE发生率,且不增加出血时间,但对长期预后无明显影响。

OBJECTIVE:To probe into the effects of antiplatelet drugs therapy guided by platelet aggregation rate on the short-term and long-term prognosis in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).METHODS:Totally 92 patients with ACS undergoing PCI admitted into Tangshan Union Medical College Hospital from Jan.2018 to Aug.2019 were selected and randomly divided into guidance group and conventional group,with 46 cases in each group.Patients in the guidance group were given antiplatelet drugs such as clopidogrel under the guidance of platelet aggregation rate after surgery,while patients in the conventional group were given conventional doses of antiplatelet drugs,both groups were treated for 1 year.Changes in thromboelastogram indicators[coagulation reaction time(R),clotting time(K)and maximum thrombus amplitude(MA)],platelet parameters[platelet count(PLT),mean platelet volume(MPV),thrombocytocrit(PCT)and platelet distribution width(PDW)]were observed before(T_(0)),1 month(T_(1))and 12 months(T_(2))after treatment,and the major adverse cardiovascular events(MACE)and bleeding complications at T_(1) and T_(2) were recorded.RESULTS:Compared with that at T_(0),the R and K were significantly longer and MA was significantly lower in both groups at T_(1) and T_(2);the R and K were significantly longer and MA was significantly lower in the guidance group than in the conventional group at T_(1),with statistically significant differences(P<0.05).Compared with that at T_(0),the PLT,MPV,PCT and PDW of both groups were significantly lower at T_(1) and T_(2);the PLT,MPV,PCT and PDW were significantly lower in the guidance group than in the conventional group at T_(1),with statistically significant differences(P<0.05).The incidence of MACE of the guidance group was significantly lower than that of the conventional group at T_(1),with statistically significant difference(P<0.05),while the difference in incidence of MACE between two groups at T_(2) was not statistically significant(P>0.05).The difference in incidence of bleeding at T_(1) and T_(2) between two groups were not statistically significant(P>0.05).CONCLUSIONS:The application of antiplatelet drug therapy guided by platelet aggregation rate can significantly reduce the incidence of recent MACE after PCI in patients with ACS,without increasing bleeding time,but has no significant effect on long-term prognosis.