摘要
目的:评价血栓弹力图法(TEG)和光学比浊法(LTA)检测经双联抗血小板药物治疗行冠脉介入术(PCI)后的急性冠脉综合征(ACS)患者氯吡格雷抵抗(CPGR)一致性,并结合CYP2C19基因酶活性程度进行相关性比较。方法:收集2016年1月~6月期间心内科经双联抗血小板治疗并行PCI后的急性冠状动脉综合征患者372例,其中CYP2C19基因酶活性快代谢148例(40%),中间代谢153例(41%),慢代谢71例(19%)。对血栓弹力图的ADP诱导的血小板抑制率(TEGADP)与ADP诱导的光学比浊法血小板聚集率(LTAADP)检测CPGR进行一致性和相关性分析,以及CYP2C19基因表达的酶活性程度与这两种方法检测CPGR的关系。结果:TEG法所测血小板抑制率检测CPGR为10.48%,LTA法所测血小板聚集率检测CPGR为11.02%。两种方法在检测CPGR上无明显差异(P>0.05)。CYP2C19基因酶活性程度与TEG法检测CPGR相关性的比较有明显差异(P<0.05),CYP2C19基因酶活性程度与LTA法检测CPGR相关性的比较无明显差异(P>0.05)。TEG法检测CPGR在CYP2C19慢代谢基因检出率为23.94%,TEG法检测CPGR在CYP2C19慢代谢基因检出率为16.90%。结论:TGE法与LTA法在监测氯吡格雷疗效上有较好的一致性,TEG法检测CPGR在CYP2C19慢代谢基因检出率更高。
Objective: To evaluate the consistency in thrombelastography( TEG) and light transmission aggregometry( LTA) in identifying clopidogrel resistance( CPGR) among patients with acute coronary syndrome( ACS) who received dual antiplatelet therapy and underwent coronary intervention( PCI),and the correlation between test results and CYP2 C19 gene enzyme activity. Methods: A total of 372 ACS patients who dual antiplatelet therapy and underwent PCI between January 2016 and June 2016 were recruited. Among them,there were 148( 40%) quick metabolizers,153( 41%) intermediate metabolizers,and 71( 19%) slow metabolizers,based on CYP2 C19 genotype. The consistency and correlation between ADP-induced platelet inhibition rate on TEG( TEGADP) and ADP-induced platelet aggregation rate on LTA( LTAADP) in detecting CPGR were analyzed. The relationship between CPGR detected with these two methods and the enzyme activity by CYP2 C19 genotype was examined. Results: The platelet inhibition rate measured by TEG was 10. 48%,and the platelet aggregation rate measured by LTA was 11.02%,with no significant difference in CPGR detection between the two methods( P>0.05). There was significant difference between the degree of CYP2 C19 gene enzymatic activity and the detection of CPGR by TEG method( P < 0. 05). There was a significant correlation between CYP2 C19 gene activity and CPEG detection by TEG( P<0.05) but not by LTA( P>0.05). CPGR was detected in 23.94% with TEG and 16.90% with LTA of slow metabolizers by CYP2 C19 genotype. Conclusion: TGE and LTA show good consistency in monitoring the treatment efficacy of clopidogrel. TEG detects more CPGR among slow metabolizers by CYP2 C19 genotype.
出处
《广州医科大学学报》
2018年第1期19-23,共5页
Academic Journal of Guangzhou Medical University
基金
广东省医学科研基金(A2015442)
