张涌,聂小燕,刘健,史录文,王伟民

• 1:北京大学人民医院心内科
• 2:北京大学药学院

摘要(Abstract)：

目的获得急性冠状动脉综合征(ACS)患者氯吡格雷用药后血小板高反应性(HPR)发生率,比较血栓弹力图(TEG)和光学比浊法(LTA)检测血小板聚集功能的相关性。方法连续入选141例年龄≤80岁的ACS患者,服用氯吡格雷≥3 d后,采用TEG法和LTA法同时检测腺苷二磷酸(ADP)诱导的血小板聚集功能,将TEG法检测出的氯吡格雷抑制率<30%或LTA法检测出最大血小板聚集率MPAR≥46%定义为HPR,比较两种方法检测结果的相关性。所有患者随访1个月,比较两种方法检测出的血小板反应预测临床不良事件的敏感性。结果采用TEG法检测出HPR患者49例(34.8%,49/141),LTA法检测出HPR 83例(58.9%,83/141),两者间比较,差异有统计学意义(χ2=16.464,P=0.000)。TEG法检测出的HPR患者总临床缺血事件发生率(10.2%,5/49)有高于同法检测的非HPR患者(5.4%,5/92)的趋势,但两者间比较差异无统计学意义(OR 1.98,95%CI0.54~7.20,P=0.480)。LTA法检测出的HPR患者总临床缺血事件发生率6.0%(5/83),与非HPR患者8.6%(5/58)比较,差异无统计学意义(OR 0.68,95%CI 0.19~2.50,P=0.797)。结论 TEG法和LTA法检测ACS患者氯吡格雷反应性相关性较差,HPR检出率有显著差异。TEG法检测出的HPR患者出院后1个月的临床缺血事件发生率有高于非HPR患者的趋势。

关键词(KeyWords)： 氯吡格雷;血小板聚集;光学比浊法;血栓弹力图;急性冠状动脉综合征

Abstract:

Keywords:

基金项目(Foundation): 北京市教育委员会青年英才计划(YETP0064)

作者(Author): 张涌,聂小燕,刘健,史录文,王伟民

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