血小板功能分析仪PFA-200 P2Y对氯吡格雷用于急性缺血性卒中二级预防的预测价值

doi:10.3969/j.issn.1004-583X.2023.11.003

摘要/Abstract

摘要：

目的探讨血小板功能分析仪(PFA)-200 P2Y 法评估血小板功能对急性缺血性卒中患者临床结局的预测价值。方法 2021年1月至2021年12月收集急性缺血性脑卒中且长期应用氯吡格雷行二级预防的患者资料,并进中位时间为1年的随访。根据预后情况将患者分为缺血性血管事件组和无缺血性血管事件组。PFA-200 P2Y测量闭合时间(CT),以检测血小板功能。记录随访期缺血性血管事件的复发情况。采用Logistic 回归分析缺血性血管事件复发的危险因素,受试者工作特征(ROC)曲线分析PFA-200 P2Y对缺血性血管事件复发的预测价值。结果纳入急性缺血性脑卒中患者142例,24例(16.9%)在随访期间发生缺血性血管事件。缺血性血管事件组P2Y水平低于无缺血性血管事件组,改良Rankin评分量表(mRS)评分高于无缺血性血管事件组,且差异有统计学意义( $P$ <0.05)。Logistic 回归分析显示,PFA-200 P2Y是急性缺血性卒中预后发生缺血性血管事件的独立危险因素( $P$ <0.05)。ROC结果显示,PFA-200 P2Y对应用氯吡格雷行缺血性卒中二级预防者发生缺血性血管事件有较好的预测价值,曲线下面积(AUC)为0.766(95% $C I$ :0.644~0.887)。结论当氯吡格雷用于急性缺血性卒中二级预防时,P2Y低水平是缺血性血管事件复发的独立危险因素,且PFA-200 P2Y结果对1年内缺血性卒中患者发生缺血性血管事件有一定预测价值。

关键词: 氯吡格雷, 缺血性卒中, 卒中, 血小板功能, 高治疗血小板反应性

Abstract:

Objective To explore the predictive value of the platelet function analyzer (PFA)-200 P2Y testing in evaluating the clinical outcome of patients with acute ischemic stroke. Methods From January 2021 to December 2021, clinical data of patients with acute ischemic stroke and long-term use of clopidogrel for secondary prevention were collected. The patients were followed up for a median of 1 year. They were divided into ischemic vascular event group and non-ischemic vascular event group according to their prognosis. The closure time (CT) was measured using the PFA-200 P2Y analyzer to detect platelet function. The recurrence of ischemic vascular events during the follow-up period was observed. Logistic regression was used to analyze the risk factors for the recurrence of ischemic vascular events, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the PFA-200 P2Y testing for the recurrence of ischemic vascular events. Results A total of 142 patients with acute ischemic stroke were included, of whom 24 (16.9%) had recurrent ischemic vascular events during the follow-up period. The level of P2Y in the ischemic vascular event group was significantly lower than that of the non-ischemic vascular event group, and the modified Rankin Scale (mRS) score was significantly higher ( $P$ <0.05). Logistic regression analysis showed that the PFA-200 P2Y testing was the independent risk factor for ischemic vascular events in the prognosis of acute ischemic stroke ( $P$ <0.05). ROC results showed that the PFA-200 P2Y testing had a good predictive value for ischemic vascular events in patients receiving clopidogrel for secondary prevention of ischemic stroke, with an area under the curve (AUC) of 0.766 (95% $C I$ : 0.644, 0.887). Conclusion Low P2Y level is an independent risk factor for recurrence of ischemic vascular events in patients with acute ischemic stroke and the use of clopidogrel for secondary prevention, and PFA-200 P2Y results have a certain predictive value for ischemic vascular events within 1 year.

Key words: clopidogrel, acute ischemic stroke, stroke, platelet function, high on-treatment platelet reactivity

中图分类号:

R743

罗伟刚, 徐玉珠, 张玲雁, 武湘云, 步玮, 任慧玲. 血小板功能分析仪PFA-200 P2Y对氯吡格雷用于急性缺血性卒中二级预防的预测价值[J]. 临床荟萃, 2023, 38(11): 979-983.

Luo Weigang, Xu Yuzhu, Zhang Lingyan, Wu Xiangyun, Bu Wei, Ren Huiling. Predictive value of the platelet function PFA-200 P2Y on the secondary prevention of acute ischemic stroke with clopidogrel[J]. Clinical Focus, 2023, 38(11): 979-983.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.11.003

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I11/979

图/表 4

表1 两组临床资料的比较[M(Q1,Q3)]

Tab. 1 Comparison of clinical data between the two groups (M[Q1, Q3])

组别	例数		年龄(岁)			男		吸烟		饮酒			NIHSS评分(分)		mRS评分(分)
缺血性血管事件组	24		70.00(57.50,75.50)			17(70.80)		10(41.70)		11(45.80)			3.00(2.00,4.00)		1.00(0.00,2.00)
无缺血性血管事件组	118		63.00(56.50,71.00)			85(72.00)		46(39.00)		41(34.70)			3.00(2.00,4.00)		0.00(0.00,1.00)
χ²/ $t$ / $Z$ 值			-1.362			0.014		0.060		1.056			-0.072		-2.230
$P$ 值			0.173			0.905		0.806		0.304			0.942		0.026
组别		高血压			糖尿病			卒中史			冠心病			总胆固醇(mmol/L)
缺血性血管事件组		16(66.70)			9(37.50)			11(45.80)			4(16.70)			4.16(3.50,4.62)
无缺血性血管事件组		80(67.80)			44(37.30)			47(39.80)			16(13.60)			4.21(3.43,5.04)
χ²/ $t$ / $Z$ 值		0.012			0.000			0.297			0.159			-0.189
$P$ 值		0.914			0.984			0.585			0.690			0.850
组别	甘油三酯 (mmol/L)			高密度脂蛋白胆固醇(mmol/L)			低密度脂蛋白胆固醇 (mmol/L)		同型半胱氨酸 (μmol/L))			糖化血红蛋白 (%)		P2Y (s)
缺血性血管事件组	1.24(1.01,1.36)			1.02(0.88,1.28)			2.21±0.80		13.70(9.68,21.45)			5.90(5.55,7.00)		63.50(57.25,127.00)
无缺血性血管事件组	1.36(1.03,2.06)			1.02(0.88,1.20)			2.56±0.79		14.50(11.35,18.55)			6.05(5.60,7.00)		127.00(82.00,233.25)
χ²/ $t$ / $Z$ 值	-1.586			-0.726			1.803		-0.473			-0.647		-0.023
$P$ 值	0.113			0.468			0.073		0.639			0.517		0.982

表1 两组临床资料的比较[M(Q1,Q3)]

Tab. 1 Comparison of clinical data between the two groups (M[Q1, Q3])

组别	例数		年龄(岁)			男		吸烟		饮酒			NIHSS评分(分)		mRS评分(分)
缺血性血管事件组	24		70.00(57.50,75.50)			17(70.80)		10(41.70)		11(45.80)			3.00(2.00,4.00)		1.00(0.00,2.00)
无缺血性血管事件组	118		63.00(56.50,71.00)			85(72.00)		46(39.00)		41(34.70)			3.00(2.00,4.00)		0.00(0.00,1.00)
χ²/ $t$ / $Z$ 值			-1.362			0.014		0.060		1.056			-0.072		-2.230
$P$ 值			0.173			0.905		0.806		0.304			0.942		0.026
组别		高血压			糖尿病			卒中史			冠心病			总胆固醇(mmol/L)
缺血性血管事件组		16(66.70)			9(37.50)			11(45.80)			4(16.70)			4.16(3.50,4.62)
无缺血性血管事件组		80(67.80)			44(37.30)			47(39.80)			16(13.60)			4.21(3.43,5.04)
χ²/ $t$ / $Z$ 值		0.012			0.000			0.297			0.159			-0.189
$P$ 值		0.914			0.984			0.585			0.690			0.850
组别	甘油三酯 (mmol/L)			高密度脂蛋白胆固醇(mmol/L)			低密度脂蛋白胆固醇 (mmol/L)		同型半胱氨酸 (μmol/L))			糖化血红蛋白 (%)		P2Y (s)
缺血性血管事件组	1.24(1.01,1.36)			1.02(0.88,1.28)			2.21±0.80		13.70(9.68,21.45)			5.90(5.55,7.00)		63.50(57.25,127.00)
无缺血性血管事件组	1.36(1.03,2.06)			1.02(0.88,1.20)			2.56±0.79		14.50(11.35,18.55)			6.05(5.60,7.00)		127.00(82.00,233.25)
χ²/ $t$ / $Z$ 值	-1.586			-0.726			1.803		-0.473			-0.647		-0.023
$P$ 值	0.113			0.468			0.073		0.639			0.517		0.982

表2 P2Y与发生缺血性血管事件相关指标的单因素分析(r)

Tab. 2 Univariate analysis of indicators related to P2Y and ischemic vascular events(r)

	NIHSS评分	mRS评分	总胆固醇	甘油三酯	高密度脂蛋白胆固醇	低密度脂蛋白胆固醇	同型半胱氨酸	糖化血红蛋白
$r$ 值	-0.028	-0.017	-0.055	0.009	-0.123	0.017	-0.063	0.042
$P$ 值	0.745	0.853	0.518	0.917	0.155	0.845	0.456	0.616

表2 P2Y与发生缺血性血管事件相关指标的单因素分析(r)

Tab. 2 Univariate analysis of indicators related to P2Y and ischemic vascular events(r)

	NIHSS评分	mRS评分	总胆固醇	甘油三酯	高密度脂蛋白胆固醇	低密度脂蛋白胆固醇	同型半胱氨酸	糖化血红蛋白
$r$ 值	-0.028	-0.017	-0.055	0.009	-0.123	0.017	-0.063	0.042
$P$ 值	0.745	0.853	0.518	0.917	0.155	0.845	0.456	0.616

表3 多因素Logistic回归分析发生缺血性血管事件的影响因素

Tab. 3 Multivariate Logistic regression analysis of influencing factors of ischemic vascular events

变量	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
P2Y	-0.010	0.005	5.078	0.024	0.990	0.981~0.999
MRS评分	0.244	0.183	1.779	0.182	1.276	0.892~1.827
甘油三酯	-0.353	0.408	0.746	0.388	0.703	0.316~1.565
低密度脂蛋白	-0.506	0.364	1.925	0.165	0.603	0.295~1.232

表3 多因素Logistic回归分析发生缺血性血管事件的影响因素

Tab. 3 Multivariate Logistic regression analysis of influencing factors of ischemic vascular events

变量	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
P2Y	-0.010	0.005	5.078	0.024	0.990	0.981~0.999
MRS评分	0.244	0.183	1.779	0.182	1.276	0.892~1.827
甘油三酯	-0.353	0.408	0.746	0.388	0.703	0.316~1.565
低密度脂蛋白	-0.506	0.364	1.925	0.165	0.603	0.295~1.232

图1 ROC曲线分析PFA-200 P2Y对应用氯吡格雷预防缺血性卒中患者发生缺血性血管事件的预测价值

Fig. 1 ROC curve analysis of PFA-200 P2Y in predicting ischemic vascular events in patients receiving clopidogrel for prevention of ischemic stroke

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