血小板功能检测与P2Y12受体拮抗剂个体化抗血小板治疗的研究进展

P2Y12受体拮抗剂广泛应用于急性冠脉综合征（ACS）及经皮冠状动脉介入治疗（PCI）后血栓事件的预防。由于抗血小板治疗反应多样性的存在，经典的P2Y12受体拮抗剂氯吡格雷的治疗期间高血小板反应性（HTPR）被证实与患者不良心血管事件的发生密切相关。尽管新药普拉格雷和替格瑞洛的抗栓疗效优于氯吡格雷，但是由于治疗期间低血小板反应性（LTPR）的存在，出血风险明显增加。如何权衡血栓和出血风险，实现个体化抗血小板治疗，已经成为临床的重要挑战。研究证实，血小板反应性（PR）与缺血和出血事件的发生密切有关，基于血小板功能检测（PFT）的治疗窗将有助于个体化抗血小板治疗。本文就PFT与P2Y12受体拮抗剂个体化抗血小板治疗的研究进展作一综述。

Platelet function test and individualized antiplatelet therapy with P2Y12 receptor antagonist: research progress

P2Y12 receptor antagonists are widely used to prevent thrombotic events in acute coronary syndromes (ACS) patients after undergoing percutaneous coronary intervention (PCI). Due to the variability of antiplatelet responsiveness, high on-treatment platelet reactivity (HTPR) has been observed to be related to cardiovascular adverse events in the patients treated with a classical P2Y12 receptor antagonist, clopidogrel. New P2Y12 receptor antagonists, such as prasugrel and ticagrelor, exert better antithrombotic effect than clopidogrel; however, higher efficacy, which is reflected by low on-treatment platelet reactivity (LTPR), increases the risk of bleeding events. How to balance the risk of thrombosis and bleeding to achieve individualized antiplatelet therapy has become an important clinical challenge. Evidence has shown that platelet reactivitcy (PR) is associated with ischemia and hemorrhage events. Therapeutic windows based on the platelet function test (PFT) will contribute to individualized antiplatelet therapy. The present review focused on the advance of PFT in individualized antiplatelet therapy with P2Y12 receptor antagonists.