光比浊法和血小板功能分析法评价P2Y12受体拮抗剂血小板反应性的比较研究

Comparative Study on Evaluation of Platelet Reactivity of P2Y12 Receptor Antagonist by LTA and VerifyNow

目的评价光比浊法(light transmittance aggregometry,LTA)和血小板功能分析法(VerifyNow)对抗血小板药物药效学指标-血小板反应性检测结果的一致性。方法纳入北京大学第一医院收治的,规律服用P2Y12受体抑制剂氯吡格雷或替格瑞洛的冠心病患者,在服药前采集谷浓度血样,使用LTA和VerifyNow两种检测方法对药效学指标血小板反应性进行检测,对两种检测方法结果之间的相关性进行spearman相关性分析;然后分别按LTA和VerifyNow将患者判定为血小板高反应性(high platelet reactivity,HPR)和血小板低反应性(low platelet reactivity,LPR),比较两种方法结果的一致性;最后根据抗血小板治疗药物将患者分为氯吡格雷组和替格瑞洛组,分析在不同药物组LTA和VerifyNow两种检测结果之间的相关性。结果共纳入116名患者,其中氯吡格雷组39人,替格瑞洛组77人。血小板反应性检测结果显示LTA和VerifyNow检测结果显著相关性,r=0.565,P=3.99×10^(-11)。但在HPR和LPR的判定方面,两种方法一致性中等(kappa=0.403)。氯吡格雷组的两种检测方法结果具有相关性,r=0.526,P=5.89×10^(-4)。替格瑞洛组血小板反应性显著低于氯吡格雷组,药效更好,但两种检测方法结果不具有相关性,r=0.120,P=0.299。结论LTA和VerifyNow检测值整体具有相关性,但在血小板反应性较低的替格瑞洛组无显著相关,两种检测方法判定出的HPR和LPR一致性中等,需要进一步改进判定的阈值。

OBJECTIVE To evaluate the consistency of platelet reactivity test results between light transmission aggregometry(LTA)and VerifyNow.METHODS In Peking University First Hospital,patients with coronary heart disease who regularly took P2Y12 receptor inhibitor clopidogrel or ticagrelor were included.Blood sample of trough concentration was collected before taking P2Y12 receptor inhibitor.The pharmacodynamic indexes platelet reactivity were detected by LTA and VerifyNow.The correlation between the results of the two detection methods was evaluated by spearman correlation analysis.Then the high platelet reactivity(HPR)and low platelet reactivity(LPR)were determined according to LTA and VerifyNow respectively,and the consistency of the results of the two methods was compared.Finally,patients using clopidogrel and ticagrelor were divided into two groups to evaluate the correlation between LTA and Verify Now,respectively.RESULTS A total of 116 patients were enrolled,including 39 patients of clopidogrel group and 77 patients of ticagrelor group.There was significant correlation between LTA and VerifyNow(r=0.565,P=3.99×10^(-11)).However,in the determination of HPR and LPR,the consistency of the two methods was medium(kappa=0.403).The results of the two methods in clopidogrel group were correlated(r=0.526,P=5.89×10^(-4)).Compared with clopidorel group,the platelet reactivity of ticagrelor group was significantly lower,which indicated better efficacy.However,there was no correlation between the results of LTA and VerifyNow in different P2Y12 receptor groups.CONCLUSION Except for the detection of LPR in ticagrelor group,platelet reactivity detected by LTA and VerifyNow is mostly correlated.The consistency of HPR and LPR determined by the two detection methods is medium,and the judgment threshold needs to be further improved.