VerifyNow-P2Y12检测法在评估氯吡格雷血小板抑制疗效中的临床应用

[Clinical application of VerifyNow-P2Y12 assay in evaluation of platelet inhibition efficacy of clopidogrel].

作者信息

Lin Shao-yi, Cui Han-bin, Chen Xiao-min, Wang Sheng-huang, Zhou Hong-lin, DU Wei-ping, Ye Hong-hua, Pan Wei-min, Yang Rui, Feng Ming-jun, Hu Ye-wen, Wang Yong, Wang Shi-qi

机构信息

Cardiovascular Center, Ningbo First Hospital, Ningbo, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Aug;40(8):662-6.

PMID:23141010

Abstract

OBJECTIVE

To evaluate the platelet inhibition efficacy in patients under regular maintenance dose of clopidogrel by VerifyNow-P2Y12 assay and explore the clinical characteristics of clopidogrel non-responders and related predicting factors.

METHODS

A total of 99 patients underwent percutaneous coronary intervention procedure and receiving clopidogrel in regular maintenance dose for at least 1 week were enrolled. Platelet reactivity, including baseline, P2Y12 reaction unit (PRU), and platelet inhibition rate were measured with VeifyNow-P2Y12 assay. The dosage of anti-platelet drugs, combination with any other drugs, clinical characters in baseline of all enrolled patients were analyzed. PRU ≤ 240 was used as cut-off to identify clopidogrel responder and clopidogrel non-responder. In the non-responder group, patients were further separated into 3 sub-groups (types) according to the baseline and platelet inhibition rate: type I with high baseline, high inhibition rate, representing false non-responder; type II with low inhibition rate, representing true non-responder and type III mixed type.

RESULTS

In this study, 48 of 99 patients were found to be clopidogrel non-responder (48.5%). The ratio of type I, type II and type III in the non-responder group was 9.1% (n = 9), 27.3% (n = 27), and 12.1% (n = 12), respectively. Baseline platelet value in female patients was significantly higher than in males (P < 0.01), number of females with high PRU also is higher than males (P < 0.01), female gender was a predict factor for type I non-responder (OR = 6.5, 95%CI 2.295 - 18.407, P < 0.01). BMI > 24 kg/m(2) was a risk factor for clopidogrel non-responder (P < 0.05), and may be regarded as a predict factor for type II non-responder (OR = 3.207, 95%CI 1.375 - 7.485, P < 0.01). Age, hypertension, diabetics, smoking, hyperlipidemia, CRP and pantoprazole use do not show significant correlation with baseline and platelet inhibition rate.

CONCLUSIONS

Clopidogrel responses could be reliably detected by VerifyNow-P2Y12 assay. Female gender and high body weight are independent risk factors for clopidogrel non-responses.

摘要

目的

通过VerifyNow-P2Y12检测评估接受氯吡格雷常规维持剂量治疗患者的血小板抑制疗效，并探讨氯吡格雷无反应者的临床特征及相关预测因素。

方法

纳入99例行经皮冠状动脉介入治疗且接受氯吡格雷常规维持剂量治疗至少1周的患者。采用VerifyNow-P2Y12检测法测量血小板反应性，包括基线、P2Y12反应单位（PRU）和血小板抑制率。分析所有纳入患者的抗血小板药物剂量、与其他任何药物的联用情况及基线临床特征。以PRU≤240作为界定氯吡格雷反应者和无反应者的切点。在无反应者组中，根据基线和血小板抑制率将患者进一步分为3个亚组（类型）：I型为基线高、抑制率高，代表假无反应者；II型为抑制率低，代表真无反应者；III型为混合型。

结果

本研究中，99例患者中有48例为氯吡格雷无反应者（48.5%）。无反应者组中I型、II型和III型的比例分别为9.1%（n = 9）、27.3%（n = 27）和12.1%（n = 12）。女性患者的基线血小板值显著高于男性（P < 0.01），PRU高的女性患者数量也高于男性（P < 0.01），女性是I型无反应者的预测因素（OR = 6.5，95%CI 2.295 - 18.407，P < 0.01）。BMI>24 kg/m²是氯吡格雷无反应者的危险因素（P < 0.05），且可被视为II型无反应者的预测因素（OR = 3.207，95%CI 1.375 - 7.485，P < 0.01）。年龄、高血压、糖尿病、吸烟、高脂血症、CRP及泮托拉唑的使用与基线和血小板抑制率均无显著相关性。