TEG在椎-基底动脉支架植入术后患者抗血小板治疗中的应用

doi:10.3760/cma.j.issn.1007-1245.2024.13.014

摘要/Abstract

摘要：

目的　比较运用血栓弹力图（TEG）结果指导的抗血小板聚集治疗与常规抗血小板聚集治疗在行椎-基底动脉支架植入术后患者中的临床疗效。方法　采用回顾性分析，选取2018年7月至2023年6月于福建中医药大学附属第二人民医院神经内科住院治疗的69例行椎-基底动脉支架植入术后患者为研究对象，术前均给予阿司匹林肠溶片（100 mg/d，qd）、氯吡格雷片（75 mg/d，qd）口服。术后根据TEG参数结果调整抗血小板治疗的患者为调整组（53例），未进行调整的常规双联抗血小板治疗患者为对照组（16例）。调整组中，男43例，女10例，年龄（68.53±11.43）岁；根据TEG参数结果是否达标进行调整抗血小板治疗方案，若花生四烯酸（AA）抑制率未达标，将阿司匹林肠溶片更换为吲哚布芬片（100 mg，bid）或西洛他唑片（100 mg，bid）；若二磷酸腺苷（ADP）抑制率未达标，将氯吡格雷片更换替格瑞洛片（90 mg，bid），治疗6个月。对照组中，男12例，女4例，年龄（68.50±9.28）岁；继续口服阿司匹林肠溶片（100 mg，qd）+硫酸氢氯吡格雷片（75 mg，qd）治疗，治疗6个月。比较两组治疗前后的总胆固醇（CHOL）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）、三酰甘油（TG）、肌酐（Cr）、尿酸（UA）、纤维蛋白原（FIB）水平，术后6个月内缺血、出血、支架内再狭窄、死亡事件的发生情况。采用独立样本t检验、Mann-Whitney U检验、χ²检验和Fisher确切概率法。结果　两组患者治疗前与治疗6个月后的CHOL、HDL-C、LDL-C、TG、Cr、UA、FIB水平比较，差异均无统计学意义（均P>0.05）。术后6个月内，两组均无死亡事件发生；调整组的缺血事件发生率为18.87%（10/53）、支架内再狭窄发生率为7.55%（4/53），均低于对照组的68.75%（11/16）、31.25%（5/16），差异均有统计学意义（χ²=12.184、P<0.001，χ²=4.177、P=0.041）；调整组发生1例（1.89%）脑出血，对照组无发生脑出血事件，两组比较差异无统计学意义（P=1.000）。结论　运用TEG结果指导椎-基底动脉支架植入术后患者的个体化抗血小板治疗较常规标准治疗临床预后效果更好。

关键词:

血栓弹力图, 椎-基底动脉支架植入术, 抗血小板治疗

Abstract:

Objective　To compare the clinical efficacies of using the results of thromboelastography (TEG) to guide the selection of antiplatelet aggregation drugs after vertebrobasilar artery stenting and the conventional use of antiplatelet aggregation drugs. Methods　This was retrospective analysis. Sixty-nine patients taking vertebral-basilar artery stenting at Department of Neurology, Second Hospital Affiliated to Fujian University of Traditional Chinese Medicine from July 2018 to June 2023 were selected as the study objects. They orally took aspirin enteric-coated tablets, 100 mg/d, qd, and clopidogrel tablets, 75 mg/d, qd. The patients whose antiplatelet therapy was adjusted according to the results of thrombologram parameters were set as an adjusted group (53 cases), and the patients whose therapy was not adjusted were set as a control group (16 cases). There were 43 males and 10 females in the adjusted group; they were (68.53±11.4) years old. There were 12 males and 4 females in the control group; they were (68.50±9.28) years old. The adjusted group's therapy was adjusted as below: if the controlled rate of arachidonic acid (AA) was not qualified, the patients took indobufen tablets (100 mg, bid) or cilostazol tablets (100 mg, bid) instead of aspirin enteric-coated tablets; if the controlled rate of adenosine diphosphate (ADP) was not qualified, the patients took ticagrelor tablets (90 mg, bid) instead of clopidogrel tablets, for 6 months. The control group continued to orally take aspirin enteric-coated tablets (100 mg, qd) and clopidogrel tablets (75 mg, qd) for 6 months. The levels of total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triacylglycerol (TG), creatinine (Cr), uric acid (UA), and fibrinogen (FIB) and the incidences of ischemic events, bleeding events, stent restenosis, and death within 6 months after operation were compared between the two groups. The independent sample t test, Mann-Whitney U test, χ² test, and Fisher's precision probability test were applied. Results　There were no statistical differences in the levels of CHOL, HDL-C, LDL-C, TG, Cr, UA, and FIB before and 6 months after the operation between the two groups (all P>0.05). Within 6 months after operation, the incidences of ischemic events and stent restenosis in the adjusted group were lower than those in the control group [18.87% (10/53) vs. 68.75% (11/16) and 7.55% (4/53) vs. 31.25% (5/16)], with statistical differences between the two groups (χ²=12.184, P<0.001; χ²=4.177, P=0.041). One case (1.89%) had brain bleeding in the adjusted group, and none in the control group, with no statistical difference between the two groups (P=1.000). Conclusion The use of thromboelastography to guide the individualized antiplatelet therapy for patients after vertebrobasilar artery stenting has better clinical prognosis than the traditional standard therapy.

Key words:

Thromboelastography, Vertebrobasilar artery stenting, Antiplatelet

张胜高丽丽廖远生.

TEG在椎-基底动脉支架植入术后患者抗血小板治疗中的应用 [J]. 国际医药卫生导报, 2024, 30(13): 2186-2190.

Zhang Sheng, Gao Lili, Liao Yuansheng.

Application of thromboelastography in patients taking antiplatelet therapy after vertebrobasilar artery stenting [J]. International Medicine and Health Guidance News, 2024, 30(13): 2186-2190.

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