血栓弹力图在心脑血管病病人抗血小板治疗中的应用价值

目的:分析服用抗血小板药物心脑血管病病人血栓弹力图（TEG）结果，为临床治疗提供参考。方法:收集因心脑血管疾病住院病人249例，根据其服用抗血小板药物情况分为阿司匹林组（AA组，n=141）、氯吡格雷组（ADP组，n=20）、阿司匹林+氯吡格雷联合组（双联组，n=88），用血栓弹力图仪检测病人血小板抑制率，分析3组抗血小板治疗的疗效差异。结果:双联组的AA途径和ADP受体途径血小板抑制率分别为（88.47±19.69）%和（68.08±28.12）%，均高于AA组的（77.71±29.7）%和ADP组的（52.57±26.97）%（P<0.01和P<0.05）。双联组的阿司匹林抵抗和氯吡格雷抵抗发生率分别为6.82%和11.36%，均低于AA组的21.99%和ADP组的30%（P<0.01和P>0.05）。结论:采用TEG仪检测心脑血管病病人的血小板聚集抑制率有利于指导临床制定个体化的抗血小板治疗方案。阿司匹林对心脑血管病人血小板聚集的抑制作用强于氯吡格雷。接受标准剂量抗血小板治疗的心脑血管病病人存在抗血小板抵抗；阿司匹林与氯吡格雷联用抗血小板有协同作用。

Application value of thrombelastogram in antiplatelet therapy in patients with cardia-cerebrovascular disease

Objective:To analyze the results of thrombelastography(TEG) in cardia-cerebrovascular disease patients treated with antiplatelet,and provide the reference for clinical therapy.Methods:Two hundred and forty-nine cardia-cerebrovascular disease patients were divided into the aspirin group(group AA,141cases),clopidogrel group(group ADP,20 cases) and aspirin and clopidogrel combination group(combination group,88 cases) according to the use of antiplatelet agent.The platelet inhibition rates in three groups were detected by thromboelastography,and the differences of the efficacy of antiplatelet treatment between three groups were compared. Results:The platelet inhibition rates in combination group induced by AA and ADP receptor pathway were (88.47 ± 19.69)% and (68.08 ± 28.12)%,respectively,which was higher than that in group AA(77.71 ± 29.7)%] and in group ADP(52.57 ± 26.97)%](P<0.01 and P<0.05).The incidence rates of aspirin and clopidogrel resistance in combination group were 6.82% and 11.36%,respectively,which was lower than that in group AA(21. 99%) and group ADP(30%)(P <0. 01 and P >0. 05). Conclusions:The inhibition rate of platelet aggregation detected by using TEG is helpful to formulate individualized antiplatelet therapy in cardia-cerebrovascular disease patients.The effect of aspirin on the inhibition of platelet aggregation in cardia-cerebrovascular disease patients is higher than that of clopidogrel.Antiplatelet resistance is found in patients treated with standard dose of antiplatelet therapy. There is a synergistic effect in the combination use of asprin and clopidogrel in antiplatelet therapy.