%0 Journal Article %T VerifyNow与TEG参数对STEMI患者PCI术后服用双联抗血小板药物出血风险的预测价值 %A 顾冰　王伟　连蕊　李长青 %J - %D 2019 %R 10.13362/j.jpmed.201903003 %X 摘要目的　探讨VerifyNow法和血栓弹力图（TEG）对不同CYP2C19基因型的ST段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入（PCI）后服用双联抗血小板药物诱发出血事件的预测价值。方法　选取2016年9月—2018年4月在我院心血管内科住院并顺利完成PCI术的STEMI患者350例。检测CYP2C19基因型，并分为快代谢组、中间代谢组以及慢代谢组。同时采用VerifyNow法检测血小板聚集反应单位（PRU），TEG法检测二磷酸腺苷（ADP）抑制率，对PRU值和ADP抑制率进行Spearman相关性分析。随访1年，建立受试者工作特征（ROC）曲线确定PRU值和ADP抑制率对出血事件的预测价值。结果　通过基因多态性检测，123例患者为CYP2C19快代谢基因型，165例患者为CYP2C19中间代谢基因型，62例患者为CYP2C19慢代谢基因型。3组不同基因型患者PRU值和ADP抑制率比较，差异有显著性（P<0.05）。CYP2C19基因快代谢型和中间代谢型患者PRU值和ADP抑制率呈线性负相关（r=－0.359、－0.446，P<0.05）。在慢代谢组患者中，9例发生出血事件的患者PRU值明显低于未出血患者，且ADP抑制率高于未出血患者（P<0.05）。PRU值对慢代谢型患者预测出血事件的ROC曲线的曲线下面积为0.704（95%CI=0.591～0.817，P<0.05），截断值为212.0。结论　VerifyNow法和TEG法在CYP2C19基因快代谢型和中间代谢型患者中的检测结果呈负相关性，且VerfiNow检测PRU值可用于预测慢代谢型患者出血事件的发生风险。
Abstract：Objective To investigate the predictive value of VerifyNow and thromboelastogram (TEG) for the risk of bleeding induced by dual antiplatelet therapy (DAPT) post percutaneous coronary interventions (PCI) in ST-elevation myocardial infarction (STEMI) patients of different CYP2C19 genotypes. Methods A total of 350 STEMI patients who were hospitalized in the Cardiovascular Department of our hospital and received a successful PCI from September 2016 to April 2018 were enrolled and divided into fast, moderate, and slow metabolism groups on the basis of their CYP2C19 genotypes tested. VerifyNow was used to determine the platelet reactivity units (PRU), and TEG was used to determine the inhibitory rate of adenosine diphosphate (ADP IR%). A Spearman correlation analysis was performed on PRU and ADP IR%. After 1 year follow-up, a receiver operating characteristic (ROC) curve was established to determine the predictive value of PRU and ADP IR% for the risk of bleeding. Results　Gene polymorphism analysis revealed that there were 123,165, and 62 patients of CYP2C19 genotypes with fast, moderate, and slow metabolism, respectively. There were significant differences in PRU and ADP IR% between patients of different genotypes in the three groups (P<0.05). In the patients of genotypes with fast or moderate metabolism, PRU were negatively correlated with ADP IR% (r=-0.359,-0.446, respectively,P<0.05). In the slow metabolism group, nine patients who had experienced bleeding had significantly lower PRU and significantly higher ADP IR% compared with those who had not experienced any bleeding (P<0.05). The area under the ROC curve and the cut-off value of PRU in predicting the risk of bleeding in patients of genotype with slow metabolism were 0.704 (95%CI=0.591-0.817,P<0.05) and 212.0, respectively. Conclusion The testing results of VerifyNow and TEG are negatively %K VerifyNow %K 血栓弹力描记术 %K ST段抬高型心肌梗死 %K 经皮冠状动脉介入治疗 %K 血小板聚集抑制剂 %K 手术后出血
VerifyNow %K Thrombelastography %K ST elevation myocardial infarction %K Percutaneous coronary intervention %K Platelet aggregation inhibitors %K Postoperative hemorrhage %U http://jpmed.qdu.edu.cn/CN/10.13362/j.jpmed.201903003