血小板功能实验预测氯吡格雷用于缺血性卒中二级预防的有效性和安全性分析

doi:10.3969/j.issn.1673-5765.2021.06.008

摘要/Abstract

摘要： 目的探讨透射光法血小板聚集实验（light transmittance aggregom etry，LTA）、血栓弹力图（thromboelastography，TEG）和血小板功能分析仪（platelet function analyzer，PFA）三种血小板功能实验对轻型缺血性卒中患者临床结局的预测价值。方法前瞻性连续收集2017年5月-2019年2月诊治为急性轻型缺血性卒中且长期服用氯吡格雷进行卒中二级预防的患者。分别采用LTA、TEG和PFA三种方法检测患者服用氯吡格雷5 d后的血小板反应性。2019年8月进行统一随访，主要终点事件为缺血性卒中复发，安全性结局为抗血小板药物相关的出血事件。比较缺血性卒中复发与未复发组、出血组与未出血组间LTA、TEG、PFA分别测定的血小板反应性差异及CYP2C19基因型分布的差异。采用受试者工作特征曲线分析血小板反应性对缺血性卒中复发的预测价值。结果研究共纳入76例患者，中位随访时间为13个月，其中5例（6.58%）患者缺血性卒中复发，17 例（22.37%）患者发生出血事件。LTA[82.00%（76.00%～85.00%）vs 44.00%（27.00%～60.50%）， P =0.005]和TEG[43.30%（34.40%～61.60%）vs 69.00%（52.45%～86.10%），P =0.032]检测的复发组血小板反应性显著高于未复发组；LTA和TEG检测结果对缺血性卒中复发有较好的预测价值[曲线下面积（area under the curve，AUC）分别为0.88（95%CI 0.73～1.00）和0.79（95%CI 0.61～0.97）]。 CYP2C19基因型和PFA检测结果均与缺血性卒中复发无关。三种血小板功能实验的结果与出血事件的发生率无关。结论当氯吡格雷用于缺血性卒中二级预防时，LTA和TEG实验对一年缺血性卒中复发有一定预测价值，但PFA预测能力欠佳。三种血小板功能实验结果与出血事件的发生无关。

文章导读： 本研究通过LTA、TEG和PFA三种血小板功能实验检测轻型缺血性卒中且规律服用氯吡格雷的患者在服药
5 d后的血小板反应性，并随访缺血性卒中复发的情况，结果显示LTA和TEG检测结果对缺血性卒中复发有较好的
预测价值。

关键词: 血小板功能实验; 缺血性卒中; 二级预防; 氯吡格雷

Abstract: Objective To evaluate the value of light transmittance aggregometry (LTA), thromboelastography (TEG) and platelet function analyzer (PFA) in predicting clinical outcome of the patients with minor ischemic stroke. Methods Acute minor ischemic stroke inpatients receiving clopidogrel for secondary prevention of ischemic stroke between May 2017 and February 2019 were consecutively collected. Residual platelet reactivity of five days after clopidogrel treatment was analyzed using LTA, TEG, and PFA. The main efficacy endpoint was recurrence of ischemic stroke, and the safety endpoint was antiplatelet therapy related bleeding. The platelet reactivity and CYP2C19 genotype were compared between recurrence group and non-recurrence group and between bleeding and non-bleeding group. Receiver operating characteristic curve analysis was used to evaluate the value of platelet function test in predicting ischemic stroke recurrence.

Results A total of 76 patients were included, and the median follow-up time was 13 months. 5

patients (6.58%) had recurrent ischemic stroke, and bleeding events occurred in 17 patients (22.37%). The on-treatment platelet reactivity by LTA [82.00% (76.00%-85.00%) vs 44.00% (27.00%-60.50%), P =0.005] and TEG [43.30% (34.40%-61.60%) vs 69.00% (52.45%-86.10%), P =0.032] analysis in patients with recurrent stroke was higher than that in patients without recurrent stroke. The area under the curve (AUC) was 0.88 (95%CI 0.73-1.00) for LTA and 0.79 (95%CI 0.61-0.97) for TEG. However, CYP2C19 genotype and PFA results were not associated with ischemic stroke recurrence. The platelet function results by the three tests were not associated with bleeding events. Conclusions LTA and TEG tests may predict 1-year recurrent ischemic stroke events in clopidogrel secondary prevention, while PFA test showed poor predictive power. None of the tests were effective in predicting antiplatelet related bleeding events.

Key words: Platelet function test; Ischemic stroke; Secondary prevention; Clopidogrel

程越, 邵腾飞, 黄丽丽, 杨丹, 徐运. 血小板功能实验预测氯吡格雷用于缺血性卒中二级预防的有效性和安全性分析[J]. 中国卒中杂志, 2021, 16(06): 574-580.

CHENG Yue, SHAO Teng-Fei, HUANG Li-Li, YANG Dan, XU Yun. Platelet Function Test in Predicting the Efficacy and Safety of Clopidogrel Secondary Prevention of Ischemic Stroke#br#[J]. Chinese Journal of Stroke, 2021, 16(06): 574-580.

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