天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (6): 663-667.doi: 10.11958/20170185

• 综述 • 上一篇    下一篇

血小板功能试验监测 P2Y12受体拮抗剂的 抗血小板聚集效果研究进展

孔繁强，任静，门剑龙△   

  1. 天津医科大学总医院医学检验科（邮编 300052）
  • 收稿日期:2017-02-16 修回日期:2017-04-10 出版日期:2017-06-15 发布日期:2017-07-05
  • 通讯作者: △通讯作者及审校者 E-mail：thromhaemo@126.com E-mail:mk5868@hotmail.com
  • 作者简介:孔繁强（1974），男，副主任技师，主要从事血液学实验室诊断及相关研究
  • 基金资助:
    天津市科技计划项目（16KPXMSF00170）

Research progress of platelet function tests in antiplatelet effect on monitoring P2Y12 receptor antagonist

KONG Fan-qiang, REN Jing, MEN Jian-long△   

  1. Medical Laboratory, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2017-02-16 Revised:2017-04-10 Published:2017-06-15 Online:2017-07-05
  • Contact: △Corresponding Author and Reviser E-mail：thromhaemo@126.com E-mail:mk5868@hotmail.com

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摘要： P2Y12受体拮抗剂广泛应用于心脑血管疾病的预防和治疗中，而监测治疗后血小板功能变化有助于改善患 者的预后。血小板功能试验是评估抗血小板聚集治疗后残留血小板高反应性的重要方法，主要包括透射光法血小 板聚集试验（LTA）、电阻抗法血小板聚集试验（WBIA）、血管舒张剂刺激磷酸蛋白（VASP）、血栓弹力图（TEG）、血小 板功能分析仪-100 型（PFA-100）和 VerifyNow 系统。这些试验监测抗血小板聚集治疗后血小板残留反应性的能力 各不相同，评估效果也各有不同。其中，LTA 是评估抗血小板药物疗效的经典方法，便捷而廉价，但易受操作和环境 干扰；WBIA 临床应用较少，缺乏评估临界值；VASP 对血小板功能变化敏感，但试验复杂且成本高；TEG 能监测药物 对血小板的抑制率，但指导治疗的安全性还需要验证；PFA-100 监测抗血小板聚集药物的敏感性和特异性尚不明 确；VerifyNow 有效可靠，但成本过高。临床研究证据显示，LTA、VASP 和 VerifyNow 系统能敏感反映 P2Y12受体拮抗 剂抗血小板聚集的效果，且与心血管疾病患者主要不良心脏事件（MACE）风险相关。

关键词: 预后, 综述, P2Y12受体拮抗剂, 血小板功能试验, 实验室临界值

Abstract: The P2Y12 receptor antagonist is used widely in prevention and treatment of cardiovascular and cerebrovascular disease. Monitoring changes of platelet function after treatment can improve the prognosis of patients. The platelet function test is the important way to evaluate high residual platelet reactivity after antiplatelet treatment, including light transmission aggregometry (LTA), whole blood impedance aggregometry assay (WBIA), vasodilator- stimulated phosphoprotein (VASP), thrombelastogram (TEG), platelet function analyzer- 100 (PFA- 100) and VerifyNow system (VerifyNow). It is very different for the reflecting ability with residual reactivity of platelets among these tests after antiplatelet therapy, and also significant difference for assessment effect. Among them, LTA is a classic method for the curative effect evaluation of anti- platelet agents, which is convenient and cheap, but it is susceptible to the operating and environment interference. The clinical application of WBIA is less, and which lacks threshold value for assessment. VASP is sensitive for the changes of platelet function, but the test is complex and expensive. TEG can monitor the inhibition ratio of drugs on anti- platelets, but it needs to verify the safety of treatment. It is not clear for sensitivity and specificity with monitoring anti-platelet agent by PFA-100. VerifyNow is effective and reliable, but the cost is high. The evidence of clinical study shows that LTA, VASP and VerifyNow can reflect the effect of platelet inhibition of P2Y12 receptor antagonists sensitively, and is associated with the risk of major adverse cardiac events (MACE) in patients with cadiovascular diseases.

Key words: prognosis, review, P2Y12receptor antagonists, platelet function test, laboratory critical values