血栓弹力图评估经皮冠状动脉介入术后双联抗血小板治疗的疗效及与临床事件的相关性

Thrombelastography in evaluating the efficacy of dual antiplatelet therapy after percutaneous coronary intervention and its correlation with clinical events

目的:探讨血栓弹力图(TEG)评估经皮冠状动脉介入(PCI)术后双联抗血小板治疗的疗效及与临床事件的相关性。方法:选取126例PCI患者为研究对象,所有患者术后均采取双联(阿司匹林与氯吡格雷)抗血小板治疗,于术后7 d采用TEG检测患者血小板功能,并根据是否发生药物抵抗分为正常组(n=82)和抵抗组(n=44)。此后随访1年,比较两组患者血红蛋白(Hb)、纤维蛋白原(FIB)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平,分析其与临床事件的相关性。结果:抵抗组血红蛋白(Hb)、纤维蛋白原(FIB)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平高于正常组(P<0.05)。多因素Logistic回归分析显示,Hb及FIB偏高是发生药物抵抗的独立危险因素(P<0.05)。两组各临床事件发生率比较,差异无统计学意义(P>0.05)。Cox回归分析显示,药物抵抗不是预测PCI术后临床事件的独立因素(P>0.05)。结论:TEG可用于评估PCI术后双联抗血小板治疗的疗效,但药物抵抗与临床事件无明显相关性。

Objective:To evaluate the efficacy of dual antiplatelet therapy after percutaneous coronary intervention(PCI)by thromboelastography(TEG)and its correlation with clinical events.Methods:126 patients with PCI were selected as the research objects.All patients were treated with dual antiplatelet therapy(aspirin and clopidogrel).Platelet function was detected by TEG on the 7th day after operation,and divided into normal group(n=82)and resistance group(n=44)according to whether drug resistance occurred.After 1 year of follow-up,the levels of hemoglobin(Hb),fibrinogen(FIB),cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)were compared between the two groups,the correlation between clinical events and antiplatelet therapy was analyzed.Results:Compared with the normal group,the levels of Hb,FIB,TC and LDL-C in the resistance group were significantly higher(P<0.05).Multivariate logistic regression analysis showed that high Hb and FIB were independent risk factors for drug resistance(P<0.05).There was no significant difference in the incidence of clinical events between the two groups(P>0.05).Cox regression analysis showed that drug resistance was not an independent factor in predicting clinical events after PCI(P>0.05).Conclusion:TEG can be used to evaluate the efficacy of dual antiplatelet therapy after PCI,but there is no significant correlation between drug resistance and clinical events.