血小板GPⅡb/Ⅲa 受体抑制剂(A辅剂)在血栓弹力图血小板聚集功能检测中的应用

目的评估以功能性纤维蛋白原(功纤杯)检测结果为标准的血栓弹力图(TEG)血小板聚集功能检测中在巴曲酶杯(A杯)内加入血小板GPⅡb/Ⅲa受体抑制剂(A辅剂)对检测结果的影响。方法从2019年12月~2020年5月在本院神经内科、心内科、综合科和康复科就诊、做TEG血小板聚集功能检测的患者中收集100(人)份全血标本,根据TEG测得的A杯血块强度(MA)值(mm)将血标本分为MA<25组(n=50)和MA≥25组(n=50),2组再各细分为A杯组(各自为n=50)、A辅剂组(在A杯中加入A辅剂)(各自为n=50)、功纤杯组(各自为n=50)3个亚组,各亚组均检测2次;比较各亚组间的血小板二磷酸腺苷(ADP)与花生四烯酸(AA)途径抑制率的线性相关(R2)、血小板抑制率的差异,以及3个亚组间ADP与AA途径药物疗效判读结果的一致性。结果 1)MA<25 mm组,血小板ADP及AA途径抑制率(%)A杯、A辅剂与功纤杯3个亚组分别为32.00±17.44 vs 30.19±17.44 vs 30.07±16.18,24.3±33.53 vs 22.53±30.9 vs 22.37±31.2(均为R2>0.975);2)MA≥25 mm组,血小板ADP及AA途径抑制率(%)A杯、A辅剂与功纤杯3个亚组分别为34.34±33.59 vs 18.45±24.42 vs 18.01±24.33,23.19±39.33 vs 8.48±21.75 vs 8.31±21.7(其中A杯组与A辅剂组比较均为R2<0.8,A辅剂组与功纤杯组均为R2>0.975);3)以功纤杯组检测结果为标准,A杯组与A辅剂组间ADP和AA途径药物疗效判读正确率分别为82%(41/50)vs 100%(50/50)、84%(42/50)vs 100%(50/50)(P<0.05),而A辅剂组与功纤杯组之间2种途径药物疗效判读结果一致(P>0.05)。结论在TEG的血小板聚集功能检测中A杯内添加A辅剂可以有效抑制A杯中非特异激活的血小板,真实反映纤维蛋白原的功能,故提高了其血小板抑制率检测结果的准确性。

Application of platelet GPⅡb/Ⅲa receptor inhibitor (A adjuvant) in the detection of platelet aggregation function

Objective To evaluate the effect of adding platelet GPⅡb/Ⅲa receptor inhibitor(A adjuvant) into the Batroxobin cup(A cup) on the accuracy of the thromboelastogram(TEG) platelet aggregation function test using the functional fibrinogen(function fiber cup) test results as a standard. Methods From December 2019 to May 2020, 100(persons) whole blood samples were collected from patients who visited the Department of Neurology, Department of Cardiology, Department of General Affairs and Department of Rehabilitation of our hospital for TEG platelet aggregation function test, and the blood standard samples were divided into MA <25 mm group(n=50) and MA≥25 mm group(n=50) according to the A-cup blood clot intensity(MA) value(mm) measured by TEG, the two groups were subdivided into A cup group(n=50, respectively), A auxiliary group(adding A auxiliary in A cup)(n=50, respectively), and functional fiber cup group(n=50, respectively), each subgroup was tested once again. The linear correlation, platelet inhibition and the consistency of drug efficacy interpretation results in platelet Adenosine diphosphate(ADP) and Arachidonic acid(AA) pathway respectively between the three subgroups were compared. Results(1) In the MA<25 mm group, the inhibition rates of ADP and AA pathway in platelet of A cup, A adjuvant and functional fibrin cup subgroups were(32.00±17.44) % vs(30.19±17.44) % vs(30.07±16.18) %,(24.3±33.53) % vs(22.53±30.9) % vs(22.37±31.2) %, respectively(R2 were all>0.975);(2) In the MA≥25 mm group, the inhibition rates of ADP and AA pathway in platelet of A cup, A adjuvant and functional fibrin cup subgroups were(34.34±33.59) % vs(18.45±24.42) % vs(18.01±24.33) %,(23.19±39.33) % vs(8.48±21.75) % vs(8.31±21.7) %( R2 between the A cup group and the A adjuvant group were all<0.8, and R2 between the A adjuvant group and the functional fibrinogen cup group were all >0.975);(3)Take the test result of the functional fibrinogen cup as the standard, the correct rates of ADP and AA pathway drug efficacy interpretation were 82%(41/50) vs 100%(50/50) and 84%(42/50) vs 100%(50/50) respectively(P<0.05) between the A-cup group and the A adjuvant group, while the interpretation results of drug efficacy of the two pathway were consistent between the A adjuvant group and the functional fibrin cup group(P>0.05).Conclusion Adding A adjuvant to TEG platelet aggregation function test can effectively inhibit non-specifically activated platelets in the A cup in the detection of platelet aggregation function, truly reflect the function of fibrinogen and improve the accuracy of platelet inhibition rate.