翟东东,王斌

• 1:北京大学航天临床医学院心内科

摘要(Abstract)：

目的探讨择期经皮冠状动脉介入治疗(PC I)患者中,使用血栓弹力图(TEG)所测定的血小板高反应性及其临床意义。方法使用TEG检测,以花生四烯酸诱导的血小板聚集率>50%和二磷酸腺苷诱导的血小板聚集率≥70%作为血小板高反应性的标准,将入选的102例PC I患者(术前3天服用阿司匹林和氯吡格雷)分为血小板高反应组(HPR)29例和血小板正常反应组(NPR)73例,比较两组患者住院期间术后胸痛、心电图、心肌酶的变化及术后6个月的心脏缺血事件的发生率。结果HPR组中女性(55.2%比24.7%,P<0.05)和糖尿病患者(41.4%比13.7%,P<0.05)的比例较NPR组高。HPR患者PC I术后心肌标志物升高比例明显高于NPR组[肌钙蛋白I(cTnI)为48.3%比15.1%,肌酸激酶MB型同工酶(CK-MB)为34.5%比6.8%,P均<0.05],6个月内缺血事件的发生率也明显高于NPR组(17.2%比1.4%,P<0.05)。结论血栓弹力图测定的具有血小板高反应性的PC I患者,其PC I术后cTnI、CK-MB水平明显升高,术后6个月临床缺血事件的发生率增加。

关键词(KeyWords)： 血栓弹力描记术;血小板;血管成形术,经腔,经皮冠状动脉

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 翟东东,王斌

参考文献(References)：

• [1]Swallow RA,Agarwala RA,Dawkins KD,et al.Thromboelas-tography:potential bedside tool to assess the effects of antiplatelettherapy?Platelets,2006,17:385-392.
• [2]Kevin P,Joseph D,Udaya ST,et al.Increased risk in patientswith high platelet aggregation receiving chronic clopidogrel thera-py undergoing percutaneous coronary intervention.J Am CollCardiol,2007,49:657-666.
• [3]Bliden KP,Tantry U,Zaman K,et al.High platelet reactivity isa risk factor for post-discharge ischemic complications following e-lective coronary stenting.J Am Coll Cardiol,2005,47:45B.
• [4]Tantry US,Bliden KP,Gurbel PA.Overestimation of platelet as-pirin resistance detection by thrombelastograph platelet mappingand validation by conventional aggregometry using arachidonicacid stimulation.J Am Coll Cardiol,2005,46:1705-1709.
• [5]Agarwal S,Coakely M,Reddy K,et al.Quantifying the effect ofantiplatelet therapy:a comparison of the platelet function analyzer(PFA-100)and modified thromboelastography(mTEG)withlight transmission platelet aggregometry.Anesthesiology,2006,105:676-683.
• [6]Bochsen L,Wiinberg B,Kjelgaard-Hansen M,et al.Evaluationof the TEG platelet mapping?assay in blood donors.Thromb J,2007,5:1-5.
• [7]Craft RM,Chavez JJ,Bresee SJ,et al.A novel modification ofthe Thrombelastograph assay,isolating platelet function,correla-ted with optical platelet aggregation.J Lab Clin Med,2004,143:301-309.
• [8]Lev EI,Patel RT,Maresh KJ.Aspirin and clopidogrel drug re-sponse in patients undergoing percutaneous coronary intervention:the role of dual drug resistance.J Am Coll Cardiol,2006,47:27-33.
• [9]Chen WH,Lee PY,Ng W,et al.Aspirin resistance is associat-ed with a high incidence of myonecrosis after nonurgent percuta-neous coronary intervention despite clopidogrel pretreatment.JAm Coll Cardiol,2004,43:1122-1126.
• [10]Ridker PM,Cook NR,Lee IM,et al.Arandomized trial of low-dose aspirin in the primary prevention of cardiovascular disease inwomen.N Engl J Med,2005,352:1293-1304.
• [11]Gurbel PA,Bliden KP,Samara W,et al.Clopidogrel effect onplatelet reactivity in patients with stent thrombosis:results of theCRESTStudy.J Am Coll Cardiol,2005,46:1827-1832.
• [12]Wenaweser P,Dorffler MJ,Imboden K,et al.Stent thrombosisis associated with an impaired response to antiplatelet therapy.JAm Coll Cardiol,2005,45:1748-1752.
• [13]Matetzky S,Shenkman B,Guetta V,et al.Clopidogrel resist-ance is associated with increased risk of recurrent atherothrombot-ic events in patients with acute myocardial infarction.Circula-tion,2004,109:3171-3175.
• [14]Nageh T,Sherwood RA,Harris BM,et al.Cardiac troponin Tand I and creatine kinase-MB as markers of myocardial injury andpredictors of outcome following percutaneous coronary interven-tion.Int J Cardiol,2003,92:285-293.