血小板活化状态检测在颅内动脉瘤支架置入术中的应用

目的探讨流式检测血小板活化状态对颅内动脉瘤支架置入术治疗的患者调整抗血小板药物的临床价值。方法对66例颅内动脉瘤患者行支架置入术治疗,术前给予常规抗血小板治疗[阿司匹林（100 mg,1次/d）＋氯吡格雷（75 mg,1次/d）]。利用流式细胞术方法监测血小板活化状态,血小板激活率〈20%,减少氯吡格雷药量;血小板激活率〉50%,增加氯吡格雷药量;血小板激活率为20%~50%,不调整药量。所有患者阿司匹林药量均不调整。结果氯吡格雷剂量未调整32例,调整为35 mg 6例、150 mg 26例、225 mg 1例,改用西洛他唑1例。药物调整后用药不当发生率（1.5%,1/66）较调整前（51.5%,34/66）明显降低（P〈0.05）。35例患者出院后随访1年,1例调整用药前即发生再缺血事件,调整用药方案后随访6个月未见再狭窄;4例药物调整前有明显的临床出血症状,调整用药方案后临床症状消失。结论流式细胞术是一种检测血小板活化状态有效的方法。流式检测结果对临床调整抗血小板药物治疗具有重要的指导作用。

Clinical value of flow cytometic monitoring of platelet activation status for patients with intracranial aneurysms after stents placement

Objective To explore the clinical value of flow cytometric monitoring of platelet activation status for patients with intracranial aneurysms after stents placement. Methods The clinical data of 66 patients with intraeranial aneurysms who underwent stents placement were analyzed retrospectively. All patients received conventional antiplatelet treatment （aspirin, 100 mg, qd; clopidogrel, 75 mg, qd） before operation. The inhibition rate of platelet aggregation was detected 3~5 days after antiplatelet treatment by flow cytometry. The dose of elopidogrel was increased when the inhibition rate of platelet aggregation was less than 20.0% or decreased when more than 50%. The dose of aspirin did not change. Results After stents placement, the doses of clopidogrel of 6, 32, 26 and 1 patients were adjusted to 35 mg, 75 mg, 150 mg and 225 mg, respectively. One patient replaced clopidogrel with cilostazol due to elopidogrel resistance. The improper dosing of clopidogrel occurred in 34 patients 3-5 days after conventional antiplatelet treatment, but it occurred only in one patient after adjusting the dose of clopidogrel according to the results of flow cytometric monitoring. Thirty-five patients were followed up for one year after hospital discharge, and the outcomes showed that restenosis occurred in one patients and gastrointestinal bleeding occurred in 4 patients. Conclusions Monitoring of platelet activation status is very important to instruct the antiplatelet treatment after stent placement in patients with intracranial aneurysms. The flow cytometry is a good method for monitoring the platelet activation status.