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投稿时间：2018-03-29 网络发布日期：2018-06-20
投稿时间：2018-03-29 网络发布日期：2018-06-20
中文摘要: 目的 探讨冠心病患者经皮冠状动脉介入术(PCI)后血浆血栓素B2(TXB2)与花生四烯酸(AA)诱导的血小板聚集率(PLAA)的相关性及其对主要不良心脑血管事件(MACCE)、出血事件的预测价值。方法 连续入选2015年5月至2016年9月300例接受PCI治疗的汉族冠心病患者。在患者口服阿司匹林肠溶片100 mg/d ≥ 5 d时采集静脉血样,应用光学血小板聚集仪检测PLAA,将PLAA ≥ 20%定义为阿司匹林抵抗(AR)。应用酶联免疫吸附法检测血浆TXB2浓度。随访患者PCI术后12个月的MACCE和出血事件;MACCE定义为心源性死亡、非致死性心肌梗死、缺血性脑卒中、心源性再入院;出血事件参照出血学术研究联合会(BARC)出血定义。结果 入选患者的AR发生率为3.33%,AR组的PLAA水平及血浆TXB2浓度均较阿司匹林敏感(AS)组显著增高[PLAA:55.50%(32.75%,72.50%)vs 3.00%(3.00%,4.00%),P<0.01],[血浆TXB2:101.39(88.60,143.42)ng/mlvs 5.40(0.77,22.98)ng/ml, P<0.01]。患者的血浆TXB2浓度和PLAA水平正相关(r=0.153,P=0.008)。在ROC曲线上取最大约登指数点血浆TXB2浓度为72.88 ng/ml,以此为诊断AR的截断值时敏感性为90.00%,特异性为95.86% [ROC曲线下面积(AUC)0.941,95% CI:0.907~0.964,P<0.01]。AR组与AS组患者MACCE和出血事件发生率无统计学差异(P>0.05)。结论 汉族冠心病患者AA诱导的血浆TXB2浓度与PLAA水平正相关,血浆TXB2水平≥72.88 ng/ml作为诊断AR的截断值时具有最高的敏感性和特异性,暂未发现PLAA与血浆TXB2水平对患者术后1年MACCE和出血事件有预测价值。
中文关键词: 冠心病 阿司匹林抵抗 血小板聚集 血浆血栓素B2 主要不良心脑血管事件
Abstract:Objective To investigate the correlation between plasma thromboxane B2 (TXB2) and arachidonic acid (AA)-induced platelet aggregation (PLAA) in patients who received percutaneous coronary intervention (PCI) and their predictive value for major adverse cardiovascular and cerebrovascular event (MACCE) and bleeding events. Methods A total of 300 patients with coronary heart disease who received PCI from May 2015 to September 2016 were selected. Venous blood samples were collected from patients who were receiving oral administration of aspirin enteric-coated tablets with the dose of 100 mg/d for not less than 5 d, and PLAA was detected by optical platelet aggregated instrument. According to the level of PLAA, all the patients were divided into aspirin resistance (AR) group (PLAA≥20%, n=10) and aspirin sensitive (AS) group (PLAA<20%, n=290). Enzyme linked immunosorbent assay (ELISA) was used to detect the plasma TXB2 concentration. All the patients were followed for 12 months after the PCI, and the MACCE (including cardiac death, non-fatal myocardial infarction, ischemic stroke and cardiac readmission) and bleeding events [referring to the definition of Bleeding Academic Research Consortium (BARC) bleeding] were recorded. Results The incidence of AR was 3.33%(10/300) in the selected patients. The PLAA level and plasma TXB2 concentration in AR group were higher than those in AS group [55.5% (32.75%, 72.50%) vs 3.00% (3.00%, 4.00%), 101.39 (88.60, 143.42) ng/ml vs 5.40 (0.77, 22.98) ng/ml, all P<0.01]. The plasma TXB2 concentration was positively correlated with the level of PLAA(r=0.153, P=0.008). In the receiver operating characteristic (ROC) curve, the maximum value of Youden′s index was when the concentration of plasma TXB2 was 72.88 ng/ml, at this time the sensitivity was 90% and the specificity was 95.86% for the diagnosis of AR [area under curve(AUC)=0.941, 95% CI:0.907 to 0.964, P<0.01]. There were no significant differences in the incidence of MACCE and bleeding events between AR and AS group (all P>0.05). Conclusion Plasma TXB2 concentration is positively correlated with PLAA level in Han patients with coronary heart disease. The plasma TXB2 level higher than 72. 88 ng/ml may be as the cut-off value for diagnosing AR, and has the highest sensitivity and specificity. There is no finding about that PLAA and plasma TXB2 levels are predictive of MACCE and bleeding events 1 years after PCI.
keywords: Coronary heart disease Aspirin resistance Platelet aggregation Thromboxane B2 Major adverse cardiovascular and cerebrovascular event
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基金项目:国家自然科学基金(81170181);江苏省医学重点人才资助项目(ZDRCA2016013)
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张晶，杨璐，王飞，范远生，梅莲莲，龚晓璇，徐可，纪矞钦，叶森，李春坚.冠心病患者血浆TXB2与PLAA及临床预后的相关性[J].中国临床研究,2018,31(6):734-737.
张晶，杨璐，王飞，范远生，梅莲莲，龚晓璇，徐可，纪矞钦，叶森，李春坚.冠心病患者血浆TXB2与PLAA及临床预后的相关性[J].中国临床研究,2018,31(6):734-737.