平均血小板体积在高风险冠状动脉介入治疗患者中对抗血小板治疗低反应的预测价值

摘要

目的 通过分析行高风险冠状动脉介入治疗(PCI)的患者中,其平均血小板体积(MPV)与抗血小板药物(阿司匹林及氯吡格雷)反应性的关系,以期了解MPV对两种药物治疗低反应的预测价值.方法 选取住院治疗的急性冠脉综合征(ACS)且行高风险PCI治疗的患者共74例.所有患者入院时即给予阿司匹林300 mg,氯吡格雷300~600 mg,次日开始予阿司匹林100 mg/d,氯吡格雷75 mg/d的维持治疗.负荷量给药24 h后采用血栓弹力图(TEG)检测阿司匹林及氯吡格雷对血小板的抑制率.以花生四烯酸(AA)诱导的血小板聚集抑制率<50%作为阿司匹林低反应的指标,据此将患者分为阿司匹林低反应组(AL)和阿司匹林敏感组(AS),以二磷酸腺苷(ADP)诱导的血小板聚集抑制率<30%作为氯吡格雷低反应的指标,将患者分为氯吡格雷低反应组(CL)和氯吡格雷敏感组(CS),分别比较不同药物两组之间临床资料、生化指标、手术相关资料及MPV水平.结果 共有27例(36.5%)患者发生CL,21例(28.4%)患者发生AL.CL组的MPV水平显著高于CS组,同样AL组的MPV水平也显著高于AS组(均P<0.05).单因素分析得出MPV增高是AL的独立预测因素.Logistic回归分析得出,CL的发生与MPV增高也有密切关系(OR=4.170,95%CI:1.971~8.823,P<0.01).根据受试者工作特性分析,MPV预测CL、AL的最佳截点分别为9.95 fL和10.65 fL,敏感性为100%和81.0%,特异性为55.3%和37.7%(CL曲线下面积:0.861,95%CI:0.779~0.942,P<0.01;AL曲线下面积:0.732,95%CI:0.609~0.856,P=0.002).结论 在高风险PCI的患者中,高MPV水平是CL、AL的独立预测指标.%Objective To explore the relationship between the initial mean platelet volume (MPV) level and the low-response to anti-platelet therapy (including aspirin and clopidogrel) assessed by thromboelastograph (TEG) platelet mapping,and analyze the predictive value of MPV on low-response to aspirin and clopidogrel in patients treated with high-risk coronary intervention.Methods 74 patients with acute coronary syndrome (ACS) who had been subjected to high-risk coronary intervention and dual-antiplatelet therapy (DAPT) were selected.TEG platelet mapping was conducted to detect platelet function.Low responses to aspirin and clopidogrel was defined as the arachidonic acid (AA)-induced inhibition of platelet aggregation (IPA) was less than 50% and the adenosine diphosphate (ADP)-induced IPA was less than 30%,respectively.All the patients in this study were divided into different groups,including clopidogrel low-responsiveness (CL) and clopidogrel sensitive (CS) groups,aspirin low-responsiveness (AL) and aspirin sensitive (AS) groups.MPV was measured by routine blood test.The clinical data of all the patients were analyzed.Results The prevalence of CL and AL were 36.5% (n=27) and 28.4% (n=21),respectively.MPV was higher in both CL and AL group than that in CS and AS group [(11.54±0.89)fL vs.(10.05±1.09)fL,(11.29±1.03)fL vs.(10.32±1.23)fL,P<0.05] The Univariate analysis and Logistic regression showed that the initial MPV was an independent predictor in both AL and CL groups (P<0.001;OR=4.170,95%CI:1.971-8.823,P<0.001).According to the result of receiving operating characteristic (ROC) curve,for CL and AL group,the best cutpoint of MPV was 9.95fL and 10.65fL,the sensitivity and specificity for differentiating between the CL and CS were 100.0% and 55.3%.as for AL and AS the results were 81.0% and 37.3%,respectively (95%CI:0.779-0.942,P<0.01;95%CI:0.609-0.856,P=0.002).Conclusions High-level of MPV is an independent predictors for both CL and AL in ACS patients treated with high-risk coronary intervention.