Siotia Anjan, Buckland Robert, Judge Heather M, Sastry Padmini, Storey Robert F
Cardiovascular Research Unit, University of Sheffield, Clinical Sciences Centre, Northern General Hospital, Sheffield, United Kingdom.
Thromb Haemost. 2006 Jun;95(6):997-1002. doi: 10.1160/TH05-08-0544.
This study aimed to establish the utility of a whole-blood single-platelet counting (WBSPC) assay, a measure of microaggregation, in monitoring the effects of tirofiban, comparing this with optical aggregometry (OA) and the Ultegra TRAP cartridge system (UTC), measures of macroaggregation. Fifty-nine patients with acute coronary syndrome scheduled for coronary angiography +/- angioplasty were studied. WBSPC assay (ADP 0.3-100 microM, Sysmex KX21 analyzer), OA (ADP 20 microM) and UTC were performed: before starting tirofiban; 30 min, 4 and 24 h after starting tirofiban; and 1 and 2 h after stopping tirofiban. Thirty minutes after starting tirofiban, there was substantial inhibition of platelet aggregation (40 +/- 30%; WBSPC, 2 minutes after addition of ADP 30 microM) and this remained stable at 4 and 24 h. OA (86 +/- 17%; inhibition of maximal aggregation, ADP 20 microM) and UTC (93 +/- 7%) showed marked inhibition with less inter-individual variation. There was no significant correlation between OA and UTC results (R(2) = 0.006), but fair correlation between OA and WBSPC results (R(2) = 0.37). Greater inhibition of macroaggregation (OA and UTC) was seen compared to microaggregation (WBSPC) such that WBSPC was more discriminating in the therapeutic range when macroaggregation was often completely inhibited. A WBSPC assay of platelet microaggregation shows promise for monitoring GPIIb/IIIa antagonists.
本研究旨在确立全血单血小板计数（WBSPC）检测法（一种微聚集检测方法）在监测替罗非班效果方面的实用性，并将其与光学聚集测定法（OA）和Ultegra TRAP检测系统（UTC）（两种大聚集检测方法）进行比较。对59例计划接受冠状动脉造影术和/或血管成形术的急性冠状动脉综合征患者进行了研究。分别在开始使用替罗非班前、开始使用替罗非班后30分钟、4小时和24小时以及停止使用替罗非班后1小时和2小时进行WBSPC检测法（使用ADP 0.3 - 100微摩尔，Sysmex KX21分析仪）、OA（使用ADP 20微摩尔）和UTC检测。开始使用替罗非班30分钟后，血小板聚集受到显著抑制（40±30%；WBSPC检测法，加入ADP 30微摩尔后2分钟），且在4小时和24小时时保持稳定。OA（86±17%；最大聚集抑制率，ADP 20微摩尔）和UTC（93±7%）显示出明显抑制，个体间差异较小。OA和UTC的检测结果之间无显著相关性（R² = 0.006），但OA和WBSPC的检测结果之间有适度相关性（R² = 0.37）。与微聚集（WBSPC）相比，大聚集（OA和UTC）受到的抑制作用更强，因此当大聚集常常被完全抑制时，WBSPC在治疗范围内更具区分性。血小板微聚集的WBSPC检测法在监测糖蛋白IIb/IIIa拮抗剂方面显示出前景。
