替格瑞洛作用下平均血小板体积对冠脉支架患者血小板反应性及临床预后的影响

Effects of mean platelet volume levels on the platelet reactivity and clinical prognosis of patients with coronary stent implantation undergoing ticagrelor

目的探讨替格瑞洛作用下平均血小板体积(MPV)对冠状动脉(冠脉)支架患者临床预后的影响。方法选取2019年8月至2020年10月于哈尔滨医科大学附属第一医院行经皮冠状动脉介入治疗(PCI)干预并接受替格瑞洛治疗的急性冠脉综合征(ACS)患者192例,根据MPV值均分为低MPV组(n=90,MPV<10.2 fl)和高MPV组(n=102,MPV≥10.2 fl),患者术前均给予负荷剂量阿司匹林(300 mg)和替格瑞洛(180 mg),随后给予维持剂量的阿司匹林(100 mg,1/d)以及替格瑞洛(90 mg,2/d),服药1周后采用血栓弹力图检测各组血小板抑制率,双重抗血小板治疗(DAPT)方案维持12个月后,停用替格瑞洛,继续服用阿司匹林(100 mg,1/d)。随访观察24个月的主要心血管不良事件(MACE),比较临床疗效。结果随访24个月后,两组患者MACE总发生率比较,差异无统计学意义(P>0.05)。两组患者服用双抗时MACE发生率比较,差异无统计学意义(P>0.05),单用阿司匹林时MACE发生率比较,差异有统计学意义(P<0.05)。MPV预测ACS患者单用阿司匹林时MACE的ROC曲线面积为0.664(95%CI:0.538~0.749,P=0.032)。结论替格瑞洛作用下MPV水平不影响血小板反应性,高MPV患者在停用替格瑞洛后MACE发生率升高。

Objective To investigate the effect of mean platelet volume(MPV)level on platelet reactivity and clinical outcome under the action of ticagrelor.Methods From August 2019 to October 2020,192 patients with acute coronary syndrome(ACS)who underwent percutaneous coronary intervention(PCI)and were treated with ticagrelor in the First Affiliated Hospital of Harbin Medical University were divided into low MPV group(n=90,MPV<10.2 fl)and high MPV group(n=102,MPV≥10.2 fl).Before the operation,all patients were given a loaded dose of aspirin(300 mg)and ticagrelor(180 mg).Subsequently,maintenance doses of aspirin(100 mg/d)and ticagrelor(90 mg/d)were given.A thromboelastogram was used to detect the platelet inhibition rate of each group after taking medicine for one week.After 12 months of the dual antiplatelet therapy(DAPT)regimen,ticagrelor was stopped,and aspirin(100 mg/d)was continued.Major adverse cardiovascular events(MACE)were followed up for 24 months to compare clinical efficacy.Results After 24 months of follow-up,there was no significant difference in the total incidence of MACE between the two groups(P>0.05).There was no significant difference in the incidence of MACE between the two groups with DAPT(P>0.05).The incidence of MACE was statistically substantial when aspirin alone was used(P<0.05).The ROC curve area of MPV that predicts MACE in patients with aspirin alone was 0.664(95%CI:0.538~0.749,P=0.032).Conclusion MPV level does not affect platelet responsiveness with ticagrelor,and the incidence of MACE increases in patients with high MPV after discontinuation of ticagrelor.