| 摘要: |
| 目的 分析血栓弹力图（thrombelastography，TEG）、血管扩张刺激磷酸蛋白（vasodilator-stimulated phosphoprotein，VASP）及国产血小板分仪PL-11与VerifyNow检测系统评估氯吡格雷对血小板聚集抑制效应的一致性，探讨其临床应用价值。方法 连续入选98例诊断为急性心肌梗死（ST-segment elevation myocardial infarction，STEMI/non ST-segment elevation myocardial infarction，NSTEMI）和经皮冠状动脉介入（percutaneous coronary intervention，PCI）术后支架内再狭窄的患者在负荷氯吡格雷600 mg 6 h后、负荷氯吡格雷300 mg 24 h后或者氯吡格雷75 mg/d>7 d，采用VerifyNow、TEG、VASP与PL-11 4种血小板检测系统同时进行检测，以VerifyNow系统的测试结果P2Y12反应单位（P2Y12 reaction units，PRU）值≥208定义为血小板高反应性（high on-clopidogrel treatment platelet reactivity，HTPR）。对4种检测方法进行相关分析，采用ROC曲线下面积（AUC）评估检测手段对HTPR的诊断价值。结果 VerifyNow系统检测血小板抑制率与TEG系统检测的血小板抑制率结果呈正相关（r=0.234，P<0.05）；与VASP磷酸化程度计算的血小板反应单位（platelet reactivity index，PRI ）、 PL-11系统检测的最大血小板聚集率、TEG系统检测二磷酸腺苷诱导的最大血块强度呈负相关（r=-0.299，P<0.01；r=-0.330，P<0.05；r=-0.237，P<0.05）；PRU值与 VerifyNow系统检测血小板抑制率呈负相关 （r=-0.815，P<0.01）。在几种血小板检测系统中，PL-11用于诊断HTPR的AUC最大，为0.644。结论 TEG、VASP、PL-11 3种血小板功能检测系统与 "金标准" VerifyNow检测系统具有一定的相关性，其中PL-11系统的敏感度和特异度最高。 |
| 关键词: 血小板功能试验 VerifyNow检测系统 血栓弹力图 PL-11血小板分析仪 血管扩张刺激磷酸蛋白 氯吡格雷 |
| DOI：10.16781/j.0258-879x.2016.08.1002 |
| 投稿时间：2015-11-24修订日期：2016-06-07 |
| 基金项目:国家科技重大专项基金（2011ZX09302-002-02）. |
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| Four detection methods for antiplatelet function of clopidogrel: a comparative study |
| YANG Ya-wei,LI Pan,CHEN Tao,LIU Yu,MA Li-ping* |
(Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To assess the consistencies of VerifyNow system, thrombelastography(TEG), vasodilator-stimulated phosphoprotein (VASP), and PL-11 platelet analyzer in detecting the antiplatelet function of clopidogrel, and to discuss the clinical application values. Methods Totally 98 consecutive inpatients with ST-segment elevation myocardial infarction (STEMI), non-(NSTEMI), or coronary artery in-stent restenosis (ISR) were included in this study. The patients were given a loading dose of 600-mg clopidogrel for 6 hours, 300-mg clopidogrel for at 24 hours, or chronic clopidogrel therapy (75 mg daily for≥7 days) before the procedure. And then the antiplatelet effects were evaluated by VerifyNow, TEG, VASP and PL-11 platelet analyzer simultaneously, with the results of VerifyNow taken as the gold standard and P2Y12 reaction unit (PRU)≥208 taken as high on-clopidogel treatment platelet reactivity (HTPR). Correlation analysis was done for the four methods, and area under ROC curve (AUC) was used to evaluate the value of each method for HTPR. Results The platelet inhibition rate detected by VerifyNow was positively correlated with that by TEG (r=0.234, P<0.05); by contrast, it was negatively correlated with the platelet reactivity index (PRI) measured by VASP, the maximum platelet aggregation rate (MAR) by PL-11 and the maximum adenosine diphosphate (MA-ADP) by TEG (r=-0.299, P<0.01; r=-0.330, P<0.05; r=-0.237, P<0.05). The PRU values was negatively correlated with the platelet inhibition rate detected by VerifyNow (r=-0.815, P<0.01). The area under ROC curve of PL-11 platelet analyzer was the highest (0.644). Conclusion TEG, VASP, and PL-11 platelet function testing systems all have consistency with the "gold standard" VerifyNow in some extent, with PL-11 platelet analyzer showing the highest sensitivity and specificity. |
| Key words: platelet function tests VerifyNow thromb elastography PL-11 platelet analyzer vasodilator-stimulated phosphoprotein clopidogrel |
