血栓弹力图评价经皮冠脉介入治疗患者服用抗血小板药物效果的研究

目的评价采用血栓弹力图观察经皮冠脉介入治疗（PCI）患者服用抗血小板药物后血小板抑制效果。方法选择住院的135例冠心病患者，其中120例接受PCI治疗并联合服用阿司匹林与氯吡格雷的患者作为联合用药组，15例未接受PCI治疗的患者（单独用药组）分别单独服用阿司匹林（阿司匹林组，8例）或氯吡格雷（氯吡格雷组，7例）。采用血栓弹力图检测花生四烯酸（AA）和磷酸腺苷（ADP）途径诱导的血小板抑制率，并比较两组抗血小板治疗的效果。结果阿司匹林组AA途径诱导的血小板抑制率为（61．66±21．44）％，高于氯吡格雷组ADP途径诱导的血小板抑制率[（55．23±13．44）％]，但差异无统计学意义（P〉0．05）；联合用药组AA和ADP途径诱导的血小板抑制率分别为（65．52±24．61）％和（58．67±22．75）％，高于阿司匹林组AA途径和氯吡格雷组ADP途径，但差异无统计学意义（P均〉0．05）；联合用药组抗血小板治疗的疗效（良好率）均优于单独应用阿司匹林或氯吡格雷组（40．00％郴12．50％，26．67％ vs 0，P均〈0．01）。结论阿司匹林与氯吡格雷均能起到很好的抗血小板作用，但氯吡格雷稍差，联合服用阿司匹林和氯吡格雷能起到更强的抗血小板作用。血栓弹力图是评价血小板抑制率的有效工具，可根据AA／ADP抑制率的情况发现对阿司匹林和／或氯吡格雷抵抗的患者，进而调整用药方案。

Evaluating effect of antiplatelet agents using thrombelastography in patients receiving PCI therapy

Objective To assess the effects of antiplatelet agents using thrombelastography for observing platelet inhibition in patients receiving percutaneous coronary intervention （PCI） after taking antiplatelet agents. Methods A total of 135 patients with coronary heart disease admitted between March 2010 and December 2011 were enrolled in this study. Among the 135 patients, 120 patients who received PCI therapy and took aspirin plus clopidogrel by oral were served as combining medication group, and 15 patients who did not receive PCI were served as pure medication group in which 8 cases were administered by oral taking aspirin （aspirin group） and 7 cases were administered by oral taking clopidogrel （ elopidogrel group）. The platelet inhibition rates induced by arachidonie acid （AA） pathway and adenosine diphosphate （ADP） pathway were detected by thrombelastography in all participants, and the effects of anti-platelet therapy were compared in each group. Results In aspirin group, the AA-induced platelet inhibition rate was（ 61.66 ± 21.44）% ; in clopidogrel group, the ADP-induced platelet inhibition rate was （55.23 ± 13.44） % ; the platelet inhibition rate in aspirin group was higher than that in clopidogrel group, but there was no statistical difference in two groups. In combining medication group,the platelet inhibition rates induced by AA and ADP pathway were （65.52 ±24.61 ） % and （58.67 ± 22.75 ） %, respectively, and they were all higher than AA pathway in asprin group and ADP pathway in elopidogrel group, but there were no statistical differences（ all P 〉 0. 05 ）. The therapeutic effect （ good rate） of anti-platelet therapy in combining medication group was superior to the effect of aspirin group （40.00% vs 12.50% , P 〈 0.01 ） or the effect of clopidogrel group （ 26.67% vs 0, P 〈 0. 01 ）. Conclusions Both aspirin and clopidogrel can play the better effects of anti-platelet aggregation, but the effect of clopidogre] is a bit poor. United taking aspirin and clopidogrel can play a more powerful role of anti-platelet aggregation. Thrombelastography is an effective tool for assessing platelet inhibition rate. The clinicians might find the aspirin/clopidogrel-resistant patients according to the situation of AA/ADP inhibition rats, and then modulate the therapeutic regimen.