血栓弹力图评价缺血性心血管病患者抗血小板药物治疗效果的价值及影响药物抵抗的相关因素分析

The Value of Thromboelastography in Evaluating the Efficacy of Antiplatelet Drugs in Patients with Ischemic Cardiovascular Disease and Analysis of the Related Factors Affecting Drug Resistance

目的 探究血栓弹力图评估缺血性心血管病(ICVD)患者抗血小板药物治疗效果的价值并分析患者发生药物抵抗的影响因素。方法 回顾性选取2022年2月~2023年2月在本院接受阿司匹林联合氯吡格雷双抗治疗的缺血性心血管病患者200例。收集其治疗7日后血栓弹力图测量结果。于服药6个月后对患者进行随访,根据药物治疗效果将患者分为治疗有效组和治疗无效组,比较2组AAi、ADPi差异,并应用ROC曲线分析AAi、ADPi对ICVD患者疗效的预测价值。统计阿司匹林抵抗和氯吡格雷抵抗发生情况并将患者分为药物抵抗组和非药物抵抗组,采用Logistic回归模型分析影响ICVD患者药物抵抗的因素。结果 治疗有效组AAi和ADPi均高于治疗无效组(P<0.05);AAi和ADPi有利于预测ICVD患者抗血小板药物治疗效果,其中二者联合检测评价ICVD药物治疗效果的价值最高,AUC为0.945,敏感度、特异度分别为96.55%、73.94%;200例患者中发生发生阿司匹林抵抗21例(10.50%)、氯吡格雷抵抗38例(19.00%)、阿司匹林和氯吡格雷双药抵抗12例(6.00%);药物抵抗组合并高血压或糖尿病、多重用药>5种、使用阿托伐他汀的比例高于非药物抵抗组(P<0.05);合并高血压或糖尿病、多重用药>5种、使用阿托伐他汀均为影响ICVD患者血小板药物抵抗的独立危险因素(P<0.05)。结论 血栓弹力图与ICVD患者抗血小板药物治疗效果密切相关,AAi和ADPi越高患者抗血小板药物治疗效果越好;合并高血压或糖尿病、多重用药>5种、使用阿托伐他汀均为影响ICVD患者血小板药物抵抗的危险因素,临床应积极关注并控制上述指标,以提高患者抗血小板药物治疗效果。

Objective To explore the value of thromboelastography in evaluating the efficacy of antiplatelet drugs in patients with ischemic cardiovascular disease(ICVD)and to analyze the influencing factors of drug resistance.Methods200 patients with ischemic cardiovascular disease who received aspirin combined with clopidogrel in our hospital from February 2022 to February 2023 were retrospectively selected.The results of thrombologram were collected 7 days after treatment.Patients were followed up 6 months after taking the drug,and the patients were divided into effective treatment group and ineffective treatment group according to the drug treatment effect.The differences of AAi and ADPi between the two groups were compared,and the predictive value of AAi and ADPi on the efficacy of ICVD patients was analyzed by ROC curve.The incidence of aspirin resistance and clopidogrel resistance were analyzed and the patients were divided into drug resistance group and non-drug resistance group.The factors affecting drug resistance in ICVD patients were analyzed by Logistic regression model.ResultsThe AAi and ADPi in the effective treatment group were higher than those in the ineffective treatment group(P<0.05).AAi and ADPi were beneficial to predict the efficacy of antiplatelet drug therapy in ICVD patients.The combination of AAI and ADPI had the highest value in evaluating the efficacy of ICVD,with AUC of 0.945,sensitivity and specificity of 96.55%and 73.94%,respectively.Among the 200 patients,21 cases(10.50%)had aspirin resistance,38 cases(19.00%)had clopidogrel resistance,and 12 cases(6.00%)had aspirin and clopidogrel resistance.Drug resistance combination with hypertension or diabetes,multiple drugs>5,the proportion of atorvastatin use was higher than non-drug resistance group(P<0.05);Hypertension or diabetes mellitus,multiple drugs>5 kinds and atorvastatin use were independent risk factors for platelet drug resistance in ICVD patients(P<0.05).ConclusionThromboelasticity is closely related to the efficacy of antiplatelet drugs in ICVD patients.The higher the AAi and ADPi,the better the efficacy of antiplatelet drugs.Hypertension or diabetes mellitus,multiple drugs>5 kinds,and atorvastatin use are all risk factors affecting platelet drug resistance in ICVD patients.The above indicators should be actively paid attention to and controlled in clinic to improve the efficacy of antiplatelet drug therapy in patients.