论文部分内容阅读
目的应用血栓弹力图(thrombelastography,TEG)分析冠状动脉介入治疗术后初始应用阿司匹林及氯吡格雷的患者血小板高反应性(high on-treatment platelet reactivity,HPR)的发生率及影响因素;分析HPR的发生与预后之间的关系。方法选取北京大学第一医院心内科2013年1月—2014年12月行冠状动脉介入治疗进行血栓弹力图血小板功能检测的冠心病患者335例。所有患者正进行阿司匹林及氯吡格雷双联抗血小板治疗。通过病案、门诊化验及门诊病历处方回顾,获得患者信息。应用血栓弹力图测定血小板抑制率,计算HPR的发生率,分析影响因素、随访临床事件及其发生时间等,分析HPR与预后的关系。采用SPSS 19.0统计软件进行数据分析,P<0.05为差异有统计学意义。结果患者阿司匹林治疗时HPR发生率为35.2%(118/335),氯吡格雷治疗时HPR发生率为34.6%(116/335)。部分临床情况对HPR的发生有所影响。完成随访308例,其中289例未调整抗血小板用药。阿司匹林治疗时HPR的发生与缺血事件存在一定联系(P=0.003),而氯吡格雷治疗时HPR与预后无明确相关性。结论 TEG检测的抗血小板药物HPR发生率较高,部分临床情况对其可能存在一定影响。阿司匹林治疗时HPR的存在与缺血事件发生有一定相关性。
Objective To investigate the incidence and influencing factors of high on-treatment platelet reactivity (HPR) in patients with initial application of aspirin and clopidogrel after coronary intervention by thrombelastography (TEG) The relationship between occurrence and prognosis. Methods From January 2013 to December 2014, 335 patients with coronary heart disease who underwent coronary artery interventional therapy to detect platelet function in thrombus elastography were selected from Department of Cardiology, Peking University First Hospital. All patients underwent dual antiplatelet therapy with aspirin and clopidogrel. Through patient records, outpatient laboratory tests and outpatient medical records review, access to patient information. Thromboelastography was used to measure the inhibition rate of platelet, calculate the incidence of HPR, analyze the influencing factors, follow-up clinical events and their occurrence time, and analyze the relationship between HPR and prognosis. SPSS 19.0 statistical software for data analysis, P <0.05 for the difference was statistically significant. Results The incidence of HPR was 35.2% (118/335) for aspirin and 34.6% (116/335) for clopidogrel. Some clinical conditions have an impact on the occurrence of HPR. A total of 308 cases were followed up, of which 289 did not receive antiplatelet therapy. The occurrence of HPR during aspirin treatment was associated with an ischemic event (P = 0.003), whereas there was no clear correlation between HPR and prognosis during clopidogrel treatment. Conclusion The incidence of HPR by anti-platelet drugs detected by TEG is high, and some clinical conditions may have some impact on it. Aspirin therapy, the presence of HPR and ischemic events have a certain relevance.