CAJ | 학술논문

目的：探讨采用血栓弹力图(TEG)评价阿司匹林和氯吡格雷治疗急性脑梗死患者的抗血小板效果,以指导对急性脑梗死患者抗血小板聚集药物治疗的个体化调整。方法选择急性脑梗死患者82例,予阿司匹林100 mg 和氯吡格雷75 mg联合治疗7 d后,采用TEG仪检测花生四烯酸(AA)途径诱导的血小板抑制率和腺苷二酸(ADP)受体途径诱导的血小板抑制率,比较患者经两种途径诱导的血小板抑制率以及患者对阿司匹林和氯吡格雷治疗反应的差异。同时选择急性脑梗死患者40例作为对照组,单用阿司匹林100 mg抗血小板治疗7d,对比两组 TEG参数(R 值、K 值、angle 角、MA 值)。结果急性脑梗死予阿司匹林、氯吡格雷双抗血小板,阿司匹林对 AA 途径的抑制率明显高于氯吡格雷对 ADP 受体途径的抑制率,差异有统计学意义(P<0.01)；对阿司匹林反应良好的患者,4例对氯吡格雷无反应,15例反应低下；对氯吡格雷反应良好的患者,仅1例对阿司匹林反应低下。对氯吡格雷反应低下者,3例对阿司匹林无反应,5例低下,6例对阿司匹林有效,15例良好。两种疗效有一定关联性(P<0.01)。对阿司匹林反应良好+有效为62例,反应低下+无效者20例；氯吡格雷反应良好+有效者42例；反应低下+无效者38例,两种药物疗效差异有统计学意义(P<0.01)。单用阿司匹林组与双联抗血小板组比较两组患者R值、K值、α角、MA值均无明显差别(P>0.05)。结论采用 TEG仪检测对急性脑梗死患者抗血小板治疗的疗效评价有较高的临床价值。双联抗血小板中阿司匹林对急性脑梗死患者血小板聚集的抑制作用强于氯吡格雷。患者对阿司匹林和氯吡格雷治疗的反应有差异性,部分对氯吡格雷反应低下者,可能对阿司匹林反应良好或有效。双联抗血小板治疗对血凝的影响较单用阿司匹林无明显差别。
목적：탐토채용혈전탄력도(TEG)평개아사필림화록필격뢰치료급성뇌경사환자적항혈소판효과,이지도대급성뇌경사환자항혈소판취집약물치료적개체화조정。방법선택급성뇌경사환자82례,여아사필림100 mg 화록필격뢰75 mg연합치료7 d후,채용TEG의검측화생사희산(AA)도경유도적혈소판억제솔화선감이산(ADP)수체도경유도적혈소판억제솔,비교환자경량충도경유도적혈소판억제솔이급환자대아사필림화록필격뢰치료반응적차이。동시선택급성뇌경사환자40례작위대조조,단용아사필림100 mg항혈소판치료7d,대비량조 TEG삼수(R 치、K 치、angle 각、MA 치)。결과급성뇌경사여아사필림、록필격뢰쌍항혈소판,아사필림대 AA 도경적억제솔명현고우록필격뢰대 ADP 수체도경적억제솔,차이유통계학의의(P<0.01)；대아사필림반응량호적환자,4례대록필격뢰무반응,15례반응저하；대록필격뢰반응량호적환자,부1례대아사필림반응저하。대록필격뢰반응저하자,3례대아사필림무반응,5례저하,6례대아사필림유효,15례량호。량충료효유일정관련성(P<0.01)。대아사필림반응량호+유효위62례,반응저하+무효자20례；록필격뢰반응량호+유효자42례；반응저하+무효자38례,량충약물료효차이유통계학의의(P<0.01)。단용아사필림조여쌍련항혈소판조비교량조환자R치、K치、α각、MA치균무명현차별(P>0.05)。결론채용 TEG의검측대급성뇌경사환자항혈소판치료적료효평개유교고적림상개치。쌍련항혈소판중아사필림대급성뇌경사환자혈소판취집적억제작용강우록필격뢰。환자대아사필림화록필격뢰치료적반응유차이성,부분대록필격뢰반응저하자,가능대아사필림반응량호혹유효。쌍련항혈소판치료대혈응적영향교단용아사필림무명현차별。
drugs.Methods 82 patients with acute cerebral infarction were selected,and all patients were treated with aspirin and clopi-dogrel for 7 days,a TEG instrument was used to detect arachidonic acid (AA)-induced inhibition rate of platelet aggrega-tion and adenosine diphosphate (ADP)receptor-induced inhibition rate of platelet aggregation.The AA pathway and ADP receptor-induced inhibition rate of platelet aggregation,as well as the response differences of the patients between aspirin and clopidogrel therapy were compared.At the same time,40 patients with acute cerebral infarction patients were selected as the control group,received 100 mg caspirin for 7 days.The parameters of TEG (R time、K time、αangle and MA)be-tween the two groups were compared.Results ① Patients with acute cerebral infarction received aspirin and clopidogrel for antiplatelet therapy,the inhibition rate of aspirin for the AA pathway was significantly higher than that of clopidogrel for the ADP receptor pathway (P<0.01).②Of those who had good response to aspirin,4 had no response to clopidogel and 1 5 had low response to clopidogel;Of those who had a good response to clopidogel,only 1 had low response to aspirin.Of those who had low response to clopidogel,3 had no response to aspirin,5 had low response to aspirin ,6 had a good re-sponse to aspirin ,and 15 had good result.The two efficacies had some relevance (P<0.01).A total of 62 patients had a good + effective response to aspirin,and 20 had low response+ineffective to aspirin,while 42 and 38 patients had good+effective and low response+ ineffective to clopidogel .There was significant difference in efficacy between the drugs (P<0. 01).There were no significant difference in R time、K time、αangle and MA between control group and dual antiplatelet group (P>0.05).Conclusion TEG instrument is valuable in assessing the efficacy of antiplatelet therapy in patients with acute cerebral infarction ,The inhibitory effect of platelet aggregation of aspirin is stronger than that of clopidogrel.The patients show differential response to aspirin and clopidogrel therapy.Some patients who have low response to clopidogrel may response well or may be effective to aspirin.There was no significant difference on blood coagulation between dual anti-platelet therapy and aspirin alone.