摘要
目的:探讨应用血栓弹力图(thromboelastography,TEG)监测冠心病(CHD)患者服用抗血小板聚集药物后体内的凝血状态以及抗血小板聚集的效果。方法:选取71例冠心病患者为CHD组和380例TEG检测结果正常的健康体检者为对照组。所有冠心病患者入院后按常规治疗方案给予临床推荐剂量的抗血小板聚集药物后用血栓弹力图仪监测凝血的基础指标(包括R值、K值、α角、MA值、CI值)及一系列血小板抑制率相关指标。结果:CHD组中患者的TEG各凝血基础指标80%以上均在正常参考值范围之内;与对照组相比,CHD组R值、MA值、α角和CI值无显著性差异,但K值显著性增高(P <0.05)。与对照组相比CHD组男性患者比率明显增多,年龄显著增高(P <0.05)。CHD组血小板抑制率在50%以上的抗血小板聚集效果显著的患者占83.10%;且以MA_(ADP)、MAck和MA_A为参考依据的抗血小板聚集的相关指标中,提示有血栓形成风险的冠心病患者分别占9.86%、4.23%和12.68%。CHD组中所有的抗血小板聚集的相关指标中,与年龄相关性最强的指标为MAck(相关系数0.111),与体质量相关性最强的指标为ADP%(相关系数0.160)。结论:TEG结果能够为临床医师提供有价值的凝血信息,并且在冠心病患者的抗血小板临床诊治上有一定的指导意义,同时TEG检测的应用还可为下一步冠心病患者的个体化临床治疗提供预判的依据,从而更加精准地指导和保障临床抗栓治疗的安全性。
Objective:To evaluate the performance of thromboelastography(TEG)to monitor in vivo blood coagulation status and the efficacy of antiplatelet aggregation drugs in the patients with coronary heart disease(CHD)after oral anticoagulation.Methods:Seventy one CHD patients were enrolled in CHD group and 380 healthy persons with normal TEG were enrolled in the control group.After admission,all CHD patients were administrated with routine anti-platelet aggregation drugs at a clinically recommended dose.Then,TEG was applied to monitor the basic blood coagulation indexes,such as R value,K value,αangle,MA value,CI value and a series of related indexes on platelet inhibition.Results:Above 80%of the basic blood coagulation indexes in TEG were within normal reference range in the CHD group.the R value,MA value,αangle and CI value in the CHD group were not significanly different,from that in the control group,but the K value significantly increased(P<0.05).Compared with the control group,relatively higher ratio of male was included in the CHD patients at much older age(P<0.05),83.1%of the CHD patients achieved significant anti-platelet aggregation effect(platelet inhibition rate>50%).Other antiplatelet aggregation indexes,MAADP,MAck and MAA suggested a 9.86%,4.23%and 12.68%risk of thrombogenesis,respectively.Among all the related antiplatelet aggregation indexes,MAck showed the strongest correlation with age(correlation coefficient,0.111),and ADP%most highly correlated with body mass(correlation coefficient,0.160).Conclusion:TEG results can provide valuable coagulation information for clinicians,thus certainly guiding in the treatment for CHD patients receiving antiplatelet therapy.Moreover,the application of TEG can also provide accurate information for further individualized treatment of CHD patients,which would funther inprove the safety of anti-thrombotic therapy.
作者
钟涛
许伟
胡海亮
刘淑均
闻慧琴
夏康
卞茂红
ZHONG Tao;XU Wei;HU Hai-Liang;LIU Shu-jun;WEN Hui-Qin;XIA Kang;BIAN Mao-Hong(Department of Blood Transfusion,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2018年第5期1484-1491,共8页
Journal of Experimental Hematology
关键词
血栓弹力图
冠心病
凝血状态
血小板抑制
thromboelastography
coronary heart disease(CHD)
coagulation status
platelet inhibition
