Kuliczkowski Wiktor, Rychlik Błażej, Chiżyński Krzysztof, Watała Cezary, Golański Jacek
Silesian Center for Heart Diseases, ul. Szpitalna 2, Zabrze, Poland.
Pol Arch Med Wewn. 2011 Apr;121(4):115-21.
It has been shown that incomplete blockade of platelet reactivity is a risk factor for future ischemic events in patients with cardiovascular diseases. Despite these findings, there is yet no gold standard of platelet reactivity estimation. The 2 most commonly used methods in platelet testing are platelet aggregometry and vasodilator-stimulated phosphoprotein phosphorylation (VASP) assay. They both showed the predictive value for future adverse events in cardiac patients; however, there are few data that compare these 2 methods.
The aim of the study was to compare the results of aggregometry (multi-electrode aggregometer [MEA]) and flow cytometric VASP assay used to determine platelet reactivity after the administration of P2Y12 receptor blockers.
The study included 17 healthy volunteers (12 men, 5 women; aged 41 ±10 years) and 12 patients (men, aged 62 ±12 years) with stable coronary artery disease treated with elective percutaneous coronary intervention with stent implantation. In volunteers, the blood was collected and tests were performed before and after 10-minute incubation with 5 nmol/l of cangrelol. In patients, the blood was collected for measurements before and after ingestion of 300 mg of clopidogrel. Aggregometry measurements included adenosine-diphosphate (ADP)-induced maximal aggregation (A(max)) and ADP-induced area under the aggregation curve (AUC). The platelet reactivity index (PRI) was determined using the VASP assay.
The use of cangrelor and clopidogrel was associated with a significant inhibition of platelet reactivity measured using the above methods. In both groups, the degree of inhibition was significantly greater when measured with the aggregation method compared with the VASP assay. The only significant coefficient of correlation between the VASP assay and aggregation results was observed in volunteers after platelet incubation with cangrelor (r= 0.81 between PRI and A(max), r = 0.68 between PRI and AUC).
Compared with the VASP assay, ADP-induced platelet aggregation shows a greater ability to detect a decrease in platelet aggregation after P2Y12 antagonists. These tests are not interchangeable because they measure different aspects of the P2Y12 receptor blockade.
已有研究表明，血小板反应性未完全被阻断是心血管疾病患者未来发生缺血性事件的一个危险因素。尽管有这些发现，但目前尚无估计血小板反应性的金标准。血小板检测中最常用的两种方法是血小板聚集测定法和血管扩张剂刺激磷蛋白磷酸化（VASP）测定法。它们都显示出对心脏病患者未来不良事件的预测价值；然而，比较这两种方法的数据很少。
本研究的目的是比较用于测定P2Y12受体阻滞剂给药后血小板反应性的聚集测定法（多电极聚集仪[MEA]）和流式细胞术VASP测定法的结果。
本研究纳入了17名健康志愿者（12名男性，5名女性；年龄41±10岁）和12名接受择期经皮冠状动脉介入治疗并植入支架的稳定型冠状动脉疾病患者（男性，年龄62±12岁）。在志愿者中，采集血液并在与5 nmol/l坎格雷洛孵育10分钟前后进行检测。在患者中，在摄入300 mg氯吡格雷前后采集血液进行测量。聚集测定测量包括二磷酸腺苷（ADP）诱导的最大聚集率（A(max)）和ADP诱导的聚集曲线下面积（AUC）。使用VASP测定法确定血小板反应性指数（PRI）。
使用坎格雷洛和氯吡格雷与使用上述方法测量的血小板反应性显著抑制相关。在两组中，与VASP测定法相比，用聚集法测量时抑制程度显著更大。仅在志愿者血小板与坎格雷洛孵育后观察到VASP测定法与聚集结果之间存在显著的相关系数（PRI与A(max)之间r = 0.81，PRI与AUC之间r = 0.68）。
与VASP测定法相比，ADP诱导的血小板聚集显示出在检测P2Y12拮抗剂后血小板聚集减少方面具有更强的能力。这些检测方法不可互换，因为它们测量的是P2Y12受体阻断的不同方面。
