摘要
目的研究全血电阻法检测血小板聚集程度对抗血小板治疗效果的评价。方法比较全血电阻法和经典的血浆光学法测定血小板聚集程度的重复性。采用全血电阻法,分别以二磷酸腺苷(ADP)、花生四烯酸和胶原为诱导剂,检测30名健康志愿者和60例服用血小板聚集抑制剂的患者的血小板聚集程度。采用 Kappa 分析比较全血电阻法和经典的血浆光学法检测血小板聚集程度的一致性。结果全血电阻法的平均 CV 值为4.8%,优于血浆光学法(CV 值为7.7%)。采用全血电阻法,分别以 ADP、花生四烯酸和胶原为诱导剂,健康志愿者的平均聚集程度分别为(9.6±3.4)Ω、(10.4±2.8)Ω和(13.5±2.2)Ω。服用阿司匹林(100 mg/d)的患者,以花生四烯酸为诱导剂,95%的患者血小板聚集程度为0Ω。服用血小板聚集抑制剂患者的血小板聚集程度显著低于健康志愿者(ADP 为诱导剂,t=2.391,P<0.05;花生四烯酸为诱导剂,t=4.057,P<0.01;胶原为诱导剂 t=2.047,P<0.05)。同时服用阿司匹林和氯吡格雷两种抑制剂的患者的血小板聚集程度显著低于单独服用阿司匹林的患者(t=3.646,P<0.01)。另外,以花生四烯酸为诱导剂,阿司匹林抵抗的患者的血小板聚集开始时间,有比健康志愿者延长的特点。经 Kappa 分析,表明全血电阻法和经典的血浆光学法两种方法检测患者对阿司匹林(Kappa=1)和氯吡格雷(Kappa=0.67)两种血小板聚集抑制剂的效果的一致性良好。结论采用全血电阻法和多种诱导剂测定血小板聚集能力对帮助临床判断抗血小板治疗的效果,辅助个体化用药是很有意义的。
Objective To study the impedance detected by the whole blood electrical impedance aggregometry in evaluating the effect of antiplatelet therapy. Methods The imprecision of the two different assays （the whole blood electrical impedance aggregometry and the plasma light transmission aggregometry） was compared. Thirty healthy volunteers and 60 patients with coronary artery disease under antiplatelet treatment were enrolled in the present study, whose anti-aggregated blood were collected for the measurement of electrical impedance in the presence of ADP, arachidonic acid and collagen, respectively. Finally, we analysed the agreement between the results of the two different assays which were used to measured the antiplatelet effect of aspirin and clopidgrel. Results The imprecision analysis showed the CV, （ the whole blood electrical impedance aggregometry was 4. 8%, superior to the plasma light transmission aggregometry （CV=7.7%）. In healthy control group, the mean impedances were（9.6 ±3.4）Ω,（10.4 ±2.8）Ω and （ 13.5 ±2. 2）Ω in the presence of ADP, arachidonic acid and collagen as in the patients taking aspirin 100 mg/day, the 95% patients＇ results were 0Ω. Furthermore, the mean impedance of patients taking aspirin 100 mg/day and/or clopidogrel 75 mg/day was significantly lower than that of healthy volunteers （ ADP as agonist,t =2. 391 ,P 〈0. 05 ;arachidonic acid as agonist,t =4. 057 ,P 〈0. 01 ;collagen as agonist t = 2. 047, P 〈 0. 05 ）. The value of patients taking 100 mg/day aspirin and 75 mg/day clopidgrel at the same time was significantly lower than that of patients taking 100 mg/day aspirin alone （t = 3. 646,P 〈 0. 01 ）. We found a longer starting aggregation time in patients suspicious to have aspirin resistance than in healthy volunteers in the presence of arachidonic acid. There was good agreement between the results from the two different assays which were used to measured the antiplatelet effect of aspirin （ Kappa value = 1 ） and clopidgrel （ Kappa value = 0. 67）. Conclusions It is important that we measure the effect of platelet aggregation inhibitors by the whole blood electrical impedance aggregometry with multi-agonist to evaluate the antiplatelet treatment effect.
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2007年第11期1260-1265,共6页
Chinese Journal of Laboratory Medicine
