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学科主题临床检验诊断学
不调整血小板数量检测血小板聚集率更适合监测抗血小板药物疗效
其他题名Light transmittance aggregometry with non-adjusted PRP is more suitable for clinical laboratory =monitoring antiplatelet therapy
苗林子1; 王建中1; 袁慧1; 袁家颖1; 赵秀清1; 邢莹1
关键词血小板聚集抑制剂 血小板计数 血小板聚集 散射测浊法和比浊法 治疗结果 Platelet Aggregation Inhibitors Platelet Count Platelet Aggregation Nephelometry And Turbidimetry Treatment Outcome
刊名中华检验医学杂志
2013
DOI10.3760/cma.j.issn.1009-9158.2013.05.006
36期:5页:405-409
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 检测冠状动脉粥样硬化性心脏病患者未服用及服用抗血小板药物后,在调整或不调整富血小板血浆(PRP)中血小板数量情况下的血小板最大聚集率,评价两种方法对监测抗血小板药物疗效的优劣.方法 本研究为方法学比对研究.选择2012年5-6月首都医科大学附属北京安贞医院560例冠状动脉粥样硬化性心脏病患者,以终浓度6 μmol/L二磷酸腺苷(ADP)及0.5 mmol/L花生四烯酸(ARA)为诱导剂,分别测定不调整PRP中血小板数量(改良法)和调整PRP中血小板数量至200×109/L(原法)标本的5 min血小板最大聚集率,比较两种方法的相关性及差异性.结果 以ADP或ARA为诱导剂时,在未服药组、服阿司匹林单药组及服阿司匹林和氯吡格雷双药组中,血小板最大聚集率和PRP中血小板数量均无相关性(-0.21≤r≤0.111,P>0.05).以ADP作为诱导剂时,原法比改良法血小板聚集率显著降低;改良法较原法各组血小板最大聚集率变异均更小;两种方法测得血小板最大聚集率在各组均有相关性(未服药组、单服阿司匹林组、服双药小于1周组、服双药大于1周组r值分别为0.78、0.73、0.40、0.71,P均<0.01).以ARA作为诱导剂时,在未服药组,原法比改良法血小板最大聚集率降低;改良法比原法血小板最大聚集率结果变异区间小,分别为62%~ 98%和5% ~ 89%;在服阿司匹林单药组及服双药组,改良法和原法均能检测到血小板最大聚集率较未服药组显著降低.结论 不调整PRP中血小板数量检测血小板聚集率的实验操作更简便、快捷,对血小板的体外影响更小,更适合临床实验室用于监测抗血小板药物疗效. Objective In this study,maximum platelet aggregation rate of Light transmittance aggregometry (LTA) for coronary heart disease(CHD) patients taking antiplatelet drug and patients without antiplatelet therapy was measured in non-adjusted and platelet count-adjusted platelet-rich plasma (PRP).The aim of this study is to compare which method is superior in evaluation of antiplatelet drug effect.Methods This is a methodology comparative research.560 CHD outpatients and inpatients that visited Beijing Anzhen Hospital of the Capital University of Medical Sciences from May to June,2012 were chosen,who were treated with aspirin monotherapy,or patients on combination therapy with aspirin and clopidogrel,as well as patients without antiplatelet therapy.LTA was performed in non-adjusted (improved method) and platelet count (200 × 109/L)-adjusted PRP (original method),using 6 μmol/L adenosine diphosphate (ADP) and 0.5 mmol/L arachidonic acid (ARA) as agonists.The maximum aggregation rates in 5 min were detected,and consistency and differences of the two methods were compared.Results There is no statistically significant correlation between maximum aggregation rate and platelet count in PRP with 6 μmol/L ADP or 0.5 mmol/L ARA as agonists in all subgroups including aspirin monotherapy,combination therapy with aspirin and clopidogrel and patients without antiplatelet therapy (-0.21 ≤ r ≤0.111,P > 0.05).The maximum aggregation rate using ADP as agonists in original method is decreased compared with improved method,there is statistically significant difference in all subgroups including patients without antiplatelet therapy,aspirin monotherapy,combination therapy with aspirin and clopidogrel less than one week and more than one week.The variability of platelet aggregation rate using ADP as agonists with improved method is lower than that with original method in all subgroups.Yet the maximum aggregation rates using ADP as agonists with improved method and original method correlate well with each other in all subgroups (r =0.78,0.73,0.40,0.71,P <0.01).In the subgroup of subjects without antiplatelet therapy using ARA as agonist,platelet aggregation rate is decreased in original method compared with improved method,there is statistically significant difference,and the variability of the aggregation rate with improved method is also lower than that with original method,ranging from 62%-98% relative to 5%-89%.The decrease of aggregation rate using ARA as agonist for patients taking antiplatelet drug compared with patients without antiplatelet therapy can be detected both with improved method and original method.Conclusion Non-adjusted PRP in LTA is more convenient and time-saving,and it also means less effects on platelet in vitro.Therefore,non-adjusted PRP is more suitable for monitoring efficacy of antiplatelet therapy in clinical laboratory.
语种中文
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/43640
专题北京大学第一临床医学院_检验科
作者单位1.100034,北京大学第一医院检验科
2.首都医科大学附属北京安贞医院检验科
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GB/T 7714
苗林子,王建中,袁慧,等. 不调整血小板数量检测血小板聚集率更适合监测抗血小板药物疗效[J]. 中华检验医学杂志,2013,36(5):405-409.
APA 苗林子,王建中,袁慧,袁家颖,赵秀清,&邢莹.(2013).不调整血小板数量检测血小板聚集率更适合监测抗血小板药物疗效.中华检验医学杂志,36(5),405-409.
MLA 苗林子,et al."不调整血小板数量检测血小板聚集率更适合监测抗血小板药物疗效".中华检验医学杂志 36.5(2013):405-409.
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