Influencing factors of medication efficacy of antiplatelet drugs in patients with cardiovascular and cerebrovascular diseases based on thromboelastogram
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摘要: 目的 探讨心脑血管疾病患者抗血小板药物使用疗效的影响因素。方法 选取2020年4月—2021年4月在南京医科大学第一附属医院进行血栓弹力图(TEG)血小板图检测的心脑血管患者363例，根据用药种类和剂量分为A、B、C、D 4组。A组术前2 h予以阿司匹林300 mg联合氯吡格雷300 mg鼻饲或纳肛，术后予以阿司匹林(100 mg/d)联合氯吡格雷(75 mg/d)口服，TEG检测时间为用药7 d左右。B组为口服阿司匹林(100 mg/d)联合氯吡格雷(75 mg/d)的患者。C组只服用阿司匹林(100 mg/d)。D组只服用氯吡格雷(75 mg/d)。比较各组间二磷腺苷酸(ADP)、花生四烯酸(AA)激活的血小板活性[MA(AA)，MA(ADP)]和抑制率(AA%，ADP%)的差异和影响因素。结果 A组的MA(AA)和MA(ADP)与其他组比较，差异有统计学意义(P < 0.05)；B组与C组的MA(AA)比较，差异有统计学意义(P=0.021)；B组与D组的MA(ADP)和ADP%差异无统计学意义(P=0.264，P=0.254)。年龄、性别、体重是抗血小板药物疗效的影响因素，而用药时长与疗效无关。结论 短期内大剂量使用抗血小板药物可以快速抗血小板防止栓塞，阿司匹林和氯吡格雷联合用药可以增强阿司匹林的抗血小板效果，对氯吡格雷无影响。体重会影响抗血小板药物的疗效，而用药时间长短不会改变药物效果。Abstract: Objective To evaluate the factors influencing the efficacy of antiplatelet drugs in patients with cardiovascular and cerebrovascular diseases.Methods From April 2020 to April 2021, 363 patients who underwent thromboelastography and platelet map test in our hospital were divided into four groups A, B, C and D according to the type and amount of medication. Group A was given aspirin 300 mg combined with clopidogrel 300 mg nasogastrically or anally 2 hours before surgery, and aspirin(100 mg/d) combined with clopidogrel(75 mg/d) orally after surgery; TEG test time was around 7 days after medication. Group B were patients taking aspirin(100 mg/d) combined with clopidogrel(75 mg/d) orally. Group C were patients taking aspirin(100 mg/d) only. Group D were patients taking clopidogrel(75 mg/d) only. The differences in platelet activity(MA[AA], MA[ADP]) and inhibition rate(AA%, ADP%), which activated by adenosine diphosphate(ADP) and arachidonic acid(AA) among the groups, and the factors affecting inhibition rate were compared.Results The MA(AA) and MA(ADP) of group A were significantly different from other groups(P < 0.05), the MA(AA) between group B and group C were significantly different(P=0.021), and the MA(ADP) and ADP% between group B and group D were not significantly different(P=0.264, P=0.254). Age, gender and body weight were factors influencing the efficacy of antiplatelet drugs, while medication duration has no correlation with medication efficacy.Conclusion High doses of antiplatelet drugs taken in the short term can quickly prevent antiplatelet embolization, and the combination of aspirin and clopidogrel can enhance the antiplatelet effect of aspirin, while having no effect on clopidogrel. Age, sex or weight can affect the efficacy of antiplatelet drugs alone, while the duration of medication does not change the efficancy.
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Key words:
- thromboelastography /
- aspirin /
- clopidogrel
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表 1 4组患者一般资料比较
因素 A组(n=189) B组(n=44) C组(n=69) D组(n=61) 男/例(%) 102(54.0) 31(70.5) 45(65.2) 38(62.3) 年龄/岁 60.8±9.9 64.2±15.7 73.9.1±14.6 77.2±14.1 体重/kg 66.3±13.5 67.3±10.3 69.7±12.1 65.9±13.9 血红蛋白/(g·L-1) 128.3±15.8 132.4±17.9 127.6±21.4 121.2±23.2 血小板计数/(×109·L-1) 175.4±50.1 230.0±57.0 210.8±96.6 193.2±90.1 诊断/例(%) 脑梗死 52(27.5) 23(52.3) 45(65.2) 30(49.2) 脑出血 29(15.3) 7(15.9) 7(10.1) 8(13.0) 颅内动脉瘤 108(57.1) 0 0 0 冠心病 0 10(22.7) 10(14.5) 19(31.1) 脑梗死合并冠心病 0 4(9.1) 7(10.1) 4(6.5) 
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表 2 4组患者MA(AA)、MA(ADP)、AA%、ADP%比较
X±S 分组 MA(AA)/mm MA(ADP)/mm AA%/% ADP%/% A组(n=189) 13.7±8.4 32.4±17.1 95.4±12.0 59.7±27.3 B组(n=44) 17.7±11.61) 44.4±12.31) 92.9±14.6 40.0±22.31) C组(n=69) 20.5±11.41)2) 87.3±21.11) D组(n=61) 41.3±14.91) 45.7±27.11) 与A组比较，1)P < 0.05；与B组比较，2)P < 0.05。
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表 3 4组患者基本资料与TEG检测结果的相关性
因素 相关系数 MA(AA) MA(ADP) AA% ADP% MA CI A组 性别 0.0171) 0.1001) 0.0321) -0.0881) 0.0511) 0.0831) 年龄 0.2751) 0.1901) -0.0621) -0.1961) -0.1081) -0.0241) 体重 0.006 0.002 0.049 -0.009 -0.0501) 0.3301) 血小板计数 0.083 -0.100 0.062 0.197 0.6621) 0.3681) 血红蛋白 0.007 -0.024 0.204 0.042 -0.0431) 0.003 B组 性别 -0.2151) -0.0271) 0.0461) -0.029 -0.011 -0.2861) 年龄 0.0731) -0.0821) -0.0501) 0.1711) 0.0841) 0.2851) 体重 -0.5581) -0.3691) 0.1861) 0.2671) -0.3611) -0.9731) 血小板计数 0.141 -0.039 -0.078 0.255 0.6521) 0.3531) 血红蛋白 -0.152 -0.104 -0.049 0.006 -0.1911) 0 C组 性别 -0.1091) — 0.1031) — 0.0741) 0.3301) 年龄 -0.1021) — 0.1931) — 0.0991) 0.285 体重 0.2041) — -0.0491) — -0.0411) -0.0421) 血小板计数 0.059 — -0.017 — 0.2601) 0.3321) 血红蛋白 -0.103 — -0.099 — -0.3741) -0.381 D组 性别 — 0.1351) — -0.0551) 0.1211) 0.1261) 年龄 — 0.0931) — -0.0841) 0.1851) 0.1141) 体重 — -0.1091) — 0.2161) 0.2341) 0.2321) 血小板计数 — 0.261 — -0.065 0.5041) 0.4761) 血红蛋白 — -0.428 — 0.3041) -0.3321) -0.231 1)双侧P < 0.05。
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表 4 抗血小板药物的TEG检测结果与药物使用时间的比较
X±S 因素 3~7 d组 8 d~1个月组 1个月~1年组 长期(超过1年)组 P B组 例数 7 16 8 13 AA%/% 96.85±2.95 90.85±20.21 94.89±9.81 91.98±13.35 0.807 ADP%/% 48.86±32.24 32.90±16.68 30.90±17.87 49.59±21.43 0.086 MA(AA)/mm 20.21±9.77 18.82±13.61 11.95±7.35 18.6±11.89 0.483 MA(ADP)/mm 41.89±16.10 48.73±9.98 44.96±11.60 40.11±12.68 0.287 C组 例数 3 AA%/% 90.78±7.67 90.22±8.88 88.01±22.30 0.935 MA(AA)/mm 24.28±8.54 14.4±5.10 19.58±11.17 0.318 D组 例数 ADP%/% 53.03±20.01 45.62±27.84 0.640 MA(ADP)/mm 44.3±19.60 40.67±14.56 0.605
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