本文選題：PFA-200　切入點(diǎn)：PFA　出處：《中國人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的①探討血小板功能分析儀PFA-200的一種新的檢測方法PFA P2Y監(jiān)測老年心血管病患者氯吡格雷治療的應(yīng)用價(jià)值;②探討血小板功能分析儀PFA-200的一種新的檢測方法PFA P2Y監(jiān)測PCI術(shù)后患者氯吡格雷治療的應(yīng)用價(jià)值。方法①選取2016年3月～2016年8月解放軍總醫(yī)院心內(nèi)科病房長期服用氯吡格雷的老年心血管病患者56例,并征集健康志愿者85例,使用PFAP2Y、LTA (light transmittance aggregometry,光學(xué)比濁法)和 TEG (thromboelasto graphy,血栓彈力圖)同時(shí)檢測所有受試者的血小板功能,評價(jià)PFA P2Y分別與LTA和TEG的相關(guān)性、符合率;②選取2016年9月～2017年4月解放軍總醫(yī)院心內(nèi)監(jiān)護(hù)室PCI術(shù)后服用雙抗(阿司匹林和氯吡格雷)的患者37例,并征集健康志愿者85例,使用PFA P2Y和TEG同時(shí)監(jiān)測所有受試者的血小板功能,評價(jià)PFA P2Y與TEG的相關(guān)性、符合率。結(jié)果①PFAP2Y、LTA和TEG三種檢測方法均顯示,服用氯吡格雷的老年心血管病患者血小板功能與健康受試者相比,結(jié)果有統(tǒng)計(jì)學(xué)差異(P0.001)。PFAP2Y vs.LTA(r=-0.701,P0.001);PFAP2Yvs.TEG(r=0.475,P0.001)。PFAP2Y vs. LTA 的符合率為 75%,κ=0.434 (P=0.001) ; PFA P2Y vs. TEG 的符合率為67.9%,κ=0.242 (P=0.046)。以LTA的MARADP (ADP誘導(dǎo)的最大血小板聚集率)50%作為實(shí)驗(yàn)室氯吡格雷抵抗標(biāo)準(zhǔn),作ROC曲線,得PFA P2Y的cut-off值為119s (AUC 0.733,靈敏度75.6%,特異度73.3%)。②PFA P2Y和TEG兩種檢測方法均顯示,服用雙抗(阿司匹林和氯比格雷)的PCI術(shù)后患者的血小板功能與健康受試者相比,結(jié)果有統(tǒng)計(jì)學(xué)差異(P0.001)。PFAP2Yvs.TEG (r=0.588,P0.001) , PFAP2Yvs.TEG 的符合率為 70.3%,κ=0.351 (P=0.012)。結(jié)論①在監(jiān)測老年心血管病患者氯吡格雷治療中,PFAP2Y與LTA具有較好的相關(guān)性和符合率,與TEG的相關(guān)性和符合率較差。PFAP2Y可用于監(jiān)測老年心血管病患者氯吡格雷的治療,cut-off值為119s,但與臨床缺血事件的相關(guān)性還有待進(jìn)一步確認(rèn)和研究。②在PCI術(shù)后患者的氯吡格雷治療監(jiān)測中,PFA P2Y與TEG的符合率較好,相關(guān)性為中等相關(guān),PFAP2Y可用于監(jiān)測PCI術(shù)后的氯吡格雷治療。
[Abstract]:Objective 1 to explore a new method for detecting PFA-200 of platelet function analyzer the value of PFA P2Y in monitoring clopidogrel treatment in elderly patients with cardiovascular diseases and to explore a new method for detecting PFA-200 of platelet function analyzer PFA P2Y. Methods the clinical value of clopidogrel after PCI was measured. 1 56 elderly patients with cardiovascular diseases who had been treated with clopidogrel for a long time from March 2016 to August 2016 in the cardiology ward of PLA General Hospital were selected. The platelet function of 85 healthy volunteers was measured by PFAP2YTa-LTA-light transmittance aggregometry (optical turbidimetry) and TEG thromboelasto graphy (thromboelastogram). The correlation between PFA P2Y and LTA and TEG was evaluated. Coincidence rate 2 selected 37 patients who had taken double antibody (aspirin and clopidogrel) after PCI in the heart care unit of PLA General Hospital from September 2016 to April 2017, and 85 healthy volunteers were recruited. The platelet function of all subjects was monitored by PFA P2Y and TEG, and the correlation between PFA P2Y and TEG was evaluated. Platelet function in elderly patients with cardiovascular disease taking clopidogrel was compared with that in healthy subjects. The results showed that there were significant differences in the coincident rate of LTA between the two groups (P 0.001n. PFAP2Y vs.LTAAP2Y vs.LTAAP2Y vs.LTAAP2Y vs.LTARG-0.701P0.001P0.001Y vs. LTA), the coincidence rate of PFA P2Y vs. TEG was 67.9 and 0.242P0.0461.The maximum platelet aggregation rate induced by MARADP MARADP was 50% as the laboratory clopidogrel resistance standard, and the ROC curve was obtained. The cut-off value of PFA P2Y was 119s AUC0.733, the sensitivity was 75.65.The specificity of 73.3%).2PFA P2Y and TEG showed that the platelet function of PCI patients who took double antibody (aspirin and clopidogrel) was compared with that of healthy subjects. Results there was a significant difference (P 0.001n. PFAP2Yvs.TEG). The coincidence rate of PFAP2Yvs.TEG was 70.3, and that of 魏 0.351 was 0.012.Conclusion 1 in the monitoring of clopidogrel treatment in elderly patients with cardiovascular diseases, the correlation between PFAP2Y and LTA was better and the coincidence rate was higher. Poor correlation and coincidence rate with TEG. PFAP2Y can be used to monitor clopidogrel in elderly patients with cardiovascular disease. The cut-off value of clopidogrel is 119s, but the correlation between clopidogrel and clinical ischemic events needs to be further confirmed and studied. 2. The coincident rate between PFAP2Y and TEG was better in the monitoring of Gray therapy. The correlation is that PFAP 2 Y can be used to monitor clopidogrel treatment after PCI.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R54;R446.1

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