PFA P2Y监测氯吡格雷治疗的研究

发布时间：2018-03-30 11:46

本文选题：PFA-200　切入点：PFA　出处：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的①探讨血小板功能分析仪PFA-200的一种新的检测方法PFA P2Y监测老年心血管病患者氯吡格雷治疗的应用价值;②探讨血小板功能分析仪PFA-200的一种新的检测方法PFA P2Y监测PCI术后患者氯吡格雷治疗的应用价值。方法①选取2016年3月～2016年8月解放军总医院心内科病房长期服用氯吡格雷的老年心血管病患者56例,并征集健康志愿者85例,使用PFAP2Y、LTA (light transmittance aggregometry,光学比浊法)和 TEG (thromboelasto graphy,血栓弹力图)同时检测所有受试者的血小板功能,评价PFA P2Y分别与LTA和TEG的相关性、符合率;②选取2016年9月～2017年4月解放军总医院心内监护室PCI术后服用双抗(阿司匹林和氯吡格雷)的患者37例,并征集健康志愿者85例,使用PFA P2Y和TEG同时监测所有受试者的血小板功能,评价PFA P2Y与TEG的相关性、符合率。结果①PFAP2Y、LTA和TEG三种检测方法均显示,服用氯吡格雷的老年心血管病患者血小板功能与健康受试者相比,结果有统计学差异(P0.001)。PFAP2Y vs.LTA(r=-0.701,P0.001);PFAP2Yvs.TEG(r=0.475,P0.001)。PFAP2Y vs. LTA 的符合率为 75%,κ=0.434 (P=0.001) ; PFA P2Y vs. TEG 的符合率为67.9%,κ=0.242 (P=0.046)。以LTA的MARADP (ADP诱导的最大血小板聚集率)50%作为实验室氯吡格雷抵抗标准,作ROC曲线,得PFA P2Y的cut-off值为119s (AUC 0.733,灵敏度75.6%,特异度73.3%)。②PFA P2Y和TEG两种检测方法均显示,服用双抗(阿司匹林和氯比格雷)的PCI术后患者的血小板功能与健康受试者相比,结果有统计学差异(P0.001)。PFAP2Yvs.TEG (r=0.588,P0.001) , PFAP2Yvs.TEG 的符合率为 70.3%,κ=0.351 (P=0.012)。结论①在监测老年心血管病患者氯吡格雷治疗中,PFAP2Y与LTA具有较好的相关性和符合率,与TEG的相关性和符合率较差。PFAP2Y可用于监测老年心血管病患者氯吡格雷的治疗,cut-off值为119s,但与临床缺血事件的相关性还有待进一步确认和研究。②在PCI术后患者的氯吡格雷治疗监测中,PFA P2Y与TEG的符合率较好,相关性为中等相关,PFAP2Y可用于监测PCI术后的氯吡格雷治疗。
[Abstract]:Objective 1 to explore a new method for detecting PFA-200 of platelet function analyzer the value of PFA P2Y in monitoring clopidogrel treatment in elderly patients with cardiovascular diseases and to explore a new method for detecting PFA-200 of platelet function analyzer PFA P2Y. Methods the clinical value of clopidogrel after PCI was measured. 1 56 elderly patients with cardiovascular diseases who had been treated with clopidogrel for a long time from March 2016 to August 2016 in the cardiology ward of PLA General Hospital were selected. The platelet function of 85 healthy volunteers was measured by PFAP2YTa-LTA-light transmittance aggregometry (optical turbidimetry) and TEG thromboelasto graphy (thromboelastogram). The correlation between PFA P2Y and LTA and TEG was evaluated. Coincidence rate 2 selected 37 patients who had taken double antibody (aspirin and clopidogrel) after PCI in the heart care unit of PLA General Hospital from September 2016 to April 2017, and 85 healthy volunteers were recruited. The platelet function of all subjects was monitored by PFA P2Y and TEG, and the correlation between PFA P2Y and TEG was evaluated. Platelet function in elderly patients with cardiovascular disease taking clopidogrel was compared with that in healthy subjects. The results showed that there were significant differences in the coincident rate of LTA between the two groups (P 0.001n. PFAP2Y vs.LTAAP2Y vs.LTAAP2Y vs.LTAAP2Y vs.LTARG-0.701P0.001P0.001Y vs. LTA), the coincidence rate of PFA P2Y vs. TEG was 67.9 and 0.242P0.0461.The maximum platelet aggregation rate induced by MARADP MARADP was 50% as the laboratory clopidogrel resistance standard, and the ROC curve was obtained. The cut-off value of PFA P2Y was 119s AUC0.733, the sensitivity was 75.65.The specificity of 73.3%).2PFA P2Y and TEG showed that the platelet function of PCI patients who took double antibody (aspirin and clopidogrel) was compared with that of healthy subjects. Results there was a significant difference (P 0.001n. PFAP2Yvs.TEG). The coincidence rate of PFAP2Yvs.TEG was 70.3, and that of 魏 0.351 was 0.012.Conclusion 1 in the monitoring of clopidogrel treatment in elderly patients with cardiovascular diseases, the correlation between PFAP2Y and LTA was better and the coincidence rate was higher. Poor correlation and coincidence rate with TEG. PFAP2Y can be used to monitor clopidogrel in elderly patients with cardiovascular disease. The cut-off value of clopidogrel is 119s, but the correlation between clopidogrel and clinical ischemic events needs to be further confirmed and studied. 2. The coincident rate between PFAP2Y and TEG was better in the monitoring of Gray therapy. The correlation is that PFAP 2 Y can be used to monitor clopidogrel treatment after PCI.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54;R446.1

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