FCM、ELISA和TEG对急性脑梗死患者抗血小板治疗的监测
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Comparison of Flow Cytometry, ELISA and Thrombelastograph Monitoring Antiplatelet Therapy in Patients with Acute Cerebral Infarction
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    目的构建受试者工作特征(ROC)曲线模式,评价不同检测方法对急性脑梗死患者阿斯匹林抵抗的监测作用,为临床阿斯匹林个体化治疗提供指导。方法对我院2010年2月到2011年10月之前未服用抗血小板药物的127例急性脑梗死患者分别在使用阿斯匹林治疗前和治疗后1周采用流式细胞术(FCM)测定全血中血小板表面糖蛋白P选择素(CD62P)表达率、酶联免疫吸附法(ELISA)定量检测尿11-脱氢血栓素B2(11-DH-TXB2)含量和血栓弹力描记术(TEG)检测花生四烯酸(AA)诱导的血小板抑制率。比较上述3种方法监测阿斯匹林抵抗(AR)的灵敏度、特异度及ROC曲线下面积(AUROC)。结果阿斯匹林治疗后CD62P表达率、尿11-DH-TXB2含量均较治疗前显著下降,血小板抑制率较治疗前有明显改善,组间比较差异均有统计学意义(p均<0.01)。CD62P、11-DH-TXB2、TEG-AA检测方法间有一定的相关性。FCM监测阿斯匹林抵抗的灵敏度、特异度和AUROC分别为86.7%、79.8%和0.805,ELISA分别为78.5%、64.7%和0.767,TEG-AA分别为81.7%、87.3%和0.984。结论TEG检测对急性脑梗死患者阿斯匹林疗效具有较高的临床应用价值,对急性脑梗死患者抗血小板个体化治疗更具指导作用。

    Abstract:

    AimTo compare three different test methods monitoring the situation of inhibited platelet function in patients with acute cerebral infarction taking aspirin orally by establishing receiver operating characteristic (ROC) curve models, and to provide guidance for individual antiplatelet therapy.MethodsFrom February 2010 to October 2011, 127 patients with acute cerebral infarction not taking antiplatelet agents before were enrolled.The rate of CD62P expression was detected with flow cytometry (FCM), urinary 11-dehydro-thromboxane B2 levels was determined quantitatively with ELISA, the AA induced platelet inhibition rate was performed with thrombelastography (TEG) before and after 7-day treatment with aspirin orally.The sensitivity, specificity, and the area under the ROC curve (AUROC) of the three methods were calculated to evaluate their effects.ResultsCD62P expression rate, urine 11-dehydro-thromboxane B2 levels and platelet aggregation rate were significantly declined after treatment in aspirin group, and the differences were statistically significant (p<0.01).After treatment CD62P, urine 11-dehydro-thromboxane B2 levels and AA-induced TEG, had a certain correlation.The sensitivity, specificity and AUROC of the three methods were as follows: CD62P 86.7%, 79.8% and 0.805;11-DH-TXB2 78.5%, 64.7% and 0.767;TEG-AA 81.7%, 87.3%and 0.984.ConclusionsTEG has a high clinical value on monitoring the efficacy of aspirin in patients with acute cerebral infarction, which can provide more individualized guidance for antiplatelet treatment.

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毛晓薇,毛伦林,李毅鸣,管阳太. FCM、ELISA和TEG对急性脑梗死患者抗血小板治疗的监测[J].中国动脉硬化杂志,2012,20(11):1013~1016.

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  • 收稿日期:2012-01-10
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