冠状动脉搭桥术后患者对抗血小板药物低反应性的危险因素分析
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摘要
目的探究行冠状动脉搭桥手术后发生高血小板反应性的影响因素。方法选择2015年5月至2016年5月行冠状动脉搭桥术并符合纳入标准的患者90例,术后服用阿司匹林肠溶片和氯吡格雷片双联抗血小板治疗且行血栓弹力图检测,查阅病案系统建档并电话随访1年,记录患者随访期间发生的缺血事件和出血事件,分为高血小板反应性组和正常血小板反应性组,评估血栓弹力图检测的高血小板反应性与冠状动脉搭桥患者对应因素的相关性。结果年龄、尿酸、谷丙转氨酶、谷草转氨酶、术中输血量、24 h引流量、手术时长、术后血栓弹力图指标(血块动力K、血块强度MA_(thrombin)、凝血综合指数CI、血块强度MA_(ADP))有统计学差异(P<0.05)。多因素二元Logistic回归分析显示尿酸升高与发生高血小板反应性呈正相关(OR=1.011,95%CI为1.003~1.019,P<0.05)。结论尿酸升高可能是导致冠状动脉搭桥患者对抗血小板药物反应低下的危险因素。
Aim To explore the influence factors of high on-treatment platelet reactivity after coronary artery bypass grafting. Methods From May 2015 to May 2016,ninety patients accordance with the inclusion criteria were enrolled in this study,and were treated with aspirin enteric-coated tablets and clopidogrel tablets double antiplatelet in combination with thrombelastogram( TEG) detection. Archives were established by consulting the case system and followed-up for 1 year. The status of ischemic events and bleeding events had been recorded by telephone during the follow-up period.The patients were divided into high on-treatment platelet reactivity( HTPR) group and normal on-treatment platelet reactivity( NTPR) group. The collected data were analyzed to evaluate the correlation between TEG detected high on-treatment platelet reactivity and some factors in patients with coronary artery bypass grafting. Results Age,uric acid,alanine aminotransferase,aspartate aminotransferase,intraoperative blood transfusion,24 h drainage,duration of operation,postoperative TEG( blood clotting K,blood clot strength MA_(thrombin),coagulation syndrome CI,blood clot strength MA_(ADP)) were statistically different( P< 0. 05). Multivariate Logistic regression analysis showed that uric acid elevation was positively correlated with occurrence of HTPR( OR = 1.011,95%CI was 1.003 ~ 1.019,P<0.05). Conclusion Serum uric acid level may be a causal risk factor for a low response to anti-platelet drugs.
Aim To explore the influence factors of high on-treatment platelet reactivity after coronary artery bypass grafting. Methods From May 2015 to May 2016,ninety patients accordance with the inclusion criteria were enrolled in this study,and were treated with aspirin enteric-coated tablets and clopidogrel tablets double antiplatelet in combination with thrombelastogram( TEG) detection. Archives were established by consulting the case system and followed-up for 1 year. The status of ischemic events and bleeding events had been recorded by telephone during the follow-up period.The patients were divided into high on-treatment platelet reactivity( HTPR) group and normal on-treatment platelet reactivity( NTPR) group. The collected data were analyzed to evaluate the correlation between TEG detected high on-treatment platelet reactivity and some factors in patients with coronary artery bypass grafting. Results Age,uric acid,alanine aminotransferase,aspartate aminotransferase,intraoperative blood transfusion,24 h drainage,duration of operation,postoperative TEG( blood clotting K,blood clot strength MA_(thrombin),coagulation syndrome CI,blood clot strength MA_(ADP)) were statistically different( P< 0. 05). Multivariate Logistic regression analysis showed that uric acid elevation was positively correlated with occurrence of HTPR( OR = 1.011,95%CI was 1.003 ~ 1.019,P<0.05). Conclusion Serum uric acid level may be a causal risk factor for a low response to anti-platelet drugs.
引文
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[2]张朝普,孙振,王林仙.冠心病合并糖尿病患者替格瑞洛、氯吡格雷的抗栓效能评价及糖基化终末产物价值分析[J].中国动脉硬化杂志,2017,25(9):909-913.
[3]Gwozdziewicz M,Němec P,Zezula R,et al.Platelet mapping in postoperative management of acute aortocoronary bypass thrombosis[J].Kardiochir Torakochir Pol,2006,3(2):214-216.
[4]王建华.实用医学科研方法[M].北京:人民卫生出版社,2003:198-200.
[5]李晓通,于忠祥,延荣强.急性冠状动脉综合征合并2型糖尿病患者冠状动脉介入术后替格瑞洛与氯吡格雷抗血小板疗效及预后[J].中国动脉硬化杂志,2015,23(12):1253-1257.
[6]Mayer K,Schulz S,Bernlochner I,et al.A comparative cohort study on personalised antiplatelet therapy in PCItreated patients with high on-clopidogrel platelet reactivity.Results of the ISAR-HPR registry[J].Thromb Haemost,2014,112(2):342-351.
[7]傅元豪,赵鸿,崔仲奇,等.再次冠状动脉旁路移植术的临床现状[J].临床医药实践,2015,24(8):616-619.
[8]王鸿雁.血栓弹力图与常规凝血四项分析凝血功能的一致性比较[J].中外医疗,2017,36(7):38-39,49.
[9]杨晓蕾.高尿酸诱导血管内皮功能紊乱致动脉粥样硬化的研究[D].辽宁:大连医科大学,2017:1-106.
[10]俞阅彦,汪世军,唐关敏.不同性别冠心病三支病变患者的危险因素分析[J].中国动脉硬化杂志,2015,23(10):1017-1020.
[11]Guthikonda S,Sinkey C,Barenz T,et al.Xanthine oxidase inhibition reverses endothelial dysfunction in heavy smokers[J].Circulation,2003,107(3):416-421.
[12]Spiel AO,Mayr FB,Firbas C,et al.Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans[J].J Thromb Haemost,2006,4(2):411-416.