血小板抑制不足与颈动脉支架植入术后不良事件的相关性研究

Association between inadequate platelet inhibition and adverse events after carotid artery stenting

目的分析血小板抑制率与颈动脉支架植入术(CAS)后不良事件的相关性。方法回顾性分析2016年1月至2022年6月复旦大学附属中山医院青浦分院149例CAS患者的临床资料,所有患者均通过血栓弹力图(TEG)评估术前血小板功能,根据有无术后不良事件分为结局不良组与结局良好组。采用t检验比较结局良好组与结局不良组组间血小板抑制率的差异,通过单因素、多因素Logistic回归分析及受试者操作特征(ROC)曲线分析血小板抑制率与不良事件的相关性。结果不良事件发生率为10.7%(16/149),结局良好组患者二磷酸腺苷(ADP)抑制率大于结局不良组(44.4%±23.5%vs 30.3%±17.8%),差异具有统计学意义(t=2.310,P=0.022)。单因素、多因素Logistic回归分析显示,较低的ADP抑制率(OR=0.45,95%CI:0.003~0.64,P=0.022)是术后不良事件的独立危险因素。ROC曲线分析显示,ADP抑制率预测CAS术后不良事件的曲线下面积为0.679(95%CI:0.557~0.802,P=0.019)。结论CAS术后不良事件与ADP抑制率不足有关,根据血小板功能检测结果调整抗血小板方案或可降低CAS术后并发症的发生率。

Objective To analyze the correlation of the platelet inhibition rate with adverse events after carotid artery stenting(CAS).Methods A total of 149 CAS patients from QingPu Branch of Zhongshan Hospital Affiliated to Fudan University between January 2016 and June 2022 were retrospectively analyzed.All patients had preoperative platelet function assessed by thromboelastography(TEG)and were divided into two groups with poor outcomes versus good outcomes according to the presence or absence of postoperative adverse events.The t-test was used to compare the differences in platelet inhibition rate between the groups with good and poor outcomes,Univariate and multivariate logistic regression analysis,receiver operating characteristic(ROC)curve were used to analyze the association between platelet inhibition rate and adverse events.Results The incidence of adverse events was 10.7%(16/149),with a statistically significant difference in adenosine diphosphate(ADP)inhibition between patients with good and adverse outcomes(44.4%±23.5%vs 30.3%±17.8%,t=2.310,P=0.022).Inadequate ADP inhibition(OR=0.45,95%CI:0.003-0.64,P=0.022)was risk factor for postoperative adverse events.ROC curve analysis showed that the area under the curve for predicting ADP inhibition after CAS adverse events was 0.679(95%CI:0.557-0.802,P=0.019).Conclusion Adverse events post-CAS are associated with ADP inhibition,and a personalized antiplatelet treatment plan based on plalet assessmentmay reduce the incidence of CAS complications.