血栓弹力图评估抗血小板药物疗效对冠状动脉支架术后支架内再狭窄的影响

Effect of antiplatelet drugs on in-stent restenosis in patients after percutaneous coronary intervention: a study evaluated by thromboelastography

摘要:

目的 应用血栓弹力图评估抗血小板药物疗效对经皮冠状动脉介入治疗术（PCI）后支架内再狭窄（ISR）的影响。方法 回顾性地分析2011年9月至2014年6月在空军总医院心脏中心成功完成PCI手术并返院复查冠状动脉造影的86例患者，按其是否发生ISR分为ISR组和非ISR组，对比分析两组之间可能引起ISR的危险因素。结果 入选的86例患者共植入药物支架118枚，其中有20人发生ISR，我们发现ISR组和非ISR组在病变长度[（27.20±3.19） vs （22.94±4.67）mm]、C反应蛋白浓度[CRP，（6.36±2.69） vs （3.14±3.23）mg/L]、腺苷二磷酸（ADP）受体抑制率[（35.80±15.58） vs （60.31±20.91）]、 尿酸和花生四烯酸（AA）途径抑制率[（68.54±17.63） vs （78.59±20.39）]、糖尿病患者比例和临床表现等方面差异有统计学意义（P＜0.05）。通过多因素回归分析，校正其他危险因素后发现ADP低抑制率（P＝0.011）是发生ISR的危险因素。结论 ADP受体的低抑制率与ISR的发生呈负相关，即氯吡格雷低反应性在ISR的发生中起重要作用。

Abstract:

Objective To determine the effect of antiplatelet drugs efficiency evaluated by thromboelastography on in-stent restenosis (ISR) in the patients after percutaneous coronary intervention (PCI). Methods A retrospective analysis was carried out on the patients undergoing successful coronary stenting and then coming back for angiography at Heart Center in Air Force General Hospital from September 2011 to June 2014. These patients were defined as ISR group and non-ISR group according to the results of coronary angiography. The possible factors that led to ISR were analyzed and compared between the 2 groups. Results There were a total of 86 patients with 118 drug-eluting stents implanted recruited in this study. ISR was found in 20 patients. There were significant differences in the lesion length [(27.20±3.19) vs (22.94±4.67)mm], the serum level of C-reactive protein [CRP, (6.36±2.69) vs (3.14±3.23)mg/L], the inhibitory rates of arachidonic acid (AA) pathway [(68.54±17.63) vs (78.59±20.39)] and adenosine 5￠-diphosphate (ADP) receptor [(35.80±15.58) vs (60.31±20.91)], the ratio of diabetes patients and the manifestations between the 2 groups (P＜0.05). Multivariate logistic regression analysis indicated that the lower inhibitory rate of ADP receptor was a risk factor of ISR (P＝0.011) after adjustment for other risk factors. Conclusion The inhibitory rate to ADP receptor is negatively related to ISR, indicating that hyporesponsiveness of clopidogrel plays an important role in the pathogenesis of ISR.