TEG-PM与药物相关基因检测指导颅内动脉瘤支架植入后抗血小板聚集治疗的应用价值

Clinical application value of TEG-PM and drug-related genetic testing in guiding against platelet aggregation therapy after stent implantation for intracranial aneurysms

目的探讨颅内动脉瘤患者行支架植入术后分别在血栓弹力图血小板图(thromboelastography-platelet mapping,TEG-PM)检测与药物相关抵抗基因检测指导下的抗血小板聚集治疗用药的安全性及有效性。方法纳入2021年1月至2022年8月昆明医科大学第一附属医院收治的颅内动脉瘤患者65例,所有患者均行阿司匹林及氯吡格雷相关基因检测,并于服用抗血小板药物后行TEG-PM。将患者随机分为A组33例,B组32例。A组在药物相关基因检测指导下行抗血小板聚集治疗,B组在TEGPM指导下行抗血小板聚集用药。比较两组术后缺血性并发症及出血性并发症发生率。结果缺血性并发症B组0例,A组2例(RR=0.492,95%CI:0.383~0.632,χ2=0.485,P=0.468),A组2例患者分别于用药后3.4个月及1.6个月出现缺血性并发症。出血性并发症A组1例,B组3例(RR=0.302,95%CI:0.303~3.069,χ2=0.300,P=0.584);A组中1例患者于术后4.33个月出现牙龈出血,B组3例患者中,2例于术后2.2个月及1.6个月无明显诱因出现皮肤散在片状青紫,1例于术后2.3个月出现黑便,完善相关检查发现消化道溃疡。结论颅内动脉瘤行支架植入术后在TEG-PM及药物相关基因检测下指导抗血小板聚集治疗安全可行,临床应用时应据患者个体化选择,并检测其指标变化,及时调整用药。

Objective To investigate the clinical safety and efficacy of the against platelet aggregation therapy under the guidance of thromboelastography-platelet mapping(TEG-PM)and drug-related resistance gene testing in treating patients with intracranial aneurysms after receiving stent implantation.Methods A total of 65 patients with intracranial aneurysms,who were admitted to the First Affiliated Hospital of Kunming Medical University of China between January 2021 and August 2022,were enrolled in this study.All patients received aspirin and clopidogrel-related genetic testing,and underwent TEG-PM check after taking antiplatelet drugs.The patients were randomly divided into group A(n=33)and group B(n=32).The patients of group A received against platelet aggregation therapy under the guidance of drug-related gene testing,while the patients of group B received against platelet aggregation therapy under the guidance of TEG-PM.The incidences of postoperative ischemic complications and hemorrhagic complications were compared between the two groups.Results The postoperative ischemic complications occurred in 0 patient of group B and in 2 patients of group A(RR=0.492,95%CI=0.383-0.632,χ2=0.485,P=0.468),and the 2 patients in group A developed ischemic complications at 3.4 months and 1.6 months after medication respectively.The postoperative hemorrhagic complication occurred in one patient of group A and in 3 patients of group B(RR=0.302,95%CI=0.303-3.069,χ2=0.300,P=0.584).The patient of group A developed gingival bleeding at 4.33 months after surgery.Among the 3 patients of group B,2 developed scattered skin patch of violet ecchymosis without obvious cause at 2.2 months and 1.6 months after surgery respectively,and the other one developed black stool at 2.3 months after surgery,which was confirmed to be caused by a gastrointestinal ulcer after relevant examinations.Conclusion For patients with intracranial aneurysms after receiving stent implantation,the against platelet aggregation therapy under the guidance of TEG-PM and drug-related resistance gene testing is clinically safe and feasible.In clinical practice,individualized selection should be made according to the specific conditions of each given patient,and it is necessary to regularly monitor the changes in indicators and timely adjust the medication.(J Intervent Radiol,2023,32:627-631)