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目的建立预测急性心肌梗死患者介入治疗后血小板高反应性的临床危险因素评分,指导临床个体化抗血小板治疗。方法纳入2013年1月至12月于北京协和医学院阜外医院行冠脉介入术治疗的547例急性心肌梗死患者,收集患者的一般临床资料及术后血栓弹力图。将血栓弹力图最大凝块强度(TEG-MAADP)>47mm定义为存在血小板高反应性。利用患者临床常用指标筛选与血小板高反应性相关的危险因素,将多因素logistic回归分析中P<0.05的临床指标纳入血小板高反应性危险评分模型,依据比值比(OR)赋予相应分值。结果 547例患者中230例(42.05%)存在血小板高反应性,TEG-MAADP值高于非血小板高反应性患者[(56.16±6.57)mm vs(26.43±13.88)mm,P<0.001]。单因素和多因素logistic回归分析发现,高龄(>75岁)、女性、合并糖尿病是血小板高反应性的独立危险因素。依据OR值权重赋予高龄(>75岁)3分,女性和合并糖尿病各赋2分,分值范围0~7分。依据得分将患者分为3组:0~2分组、3~5分组和6~7分组,结果显示3组间血小板反应性差异有统计学意义,0~2分组患者的血小板反应性低于3~5分和6~7分组[(37.79±18.45)mm vs(50.04±15.91)mm vs(56.50±15.78)mm;P<0.001]。受试者工作特征曲线分析显示得分>2分能有效预测是否存在血小板高反应性(曲线下面积为0.627,95%CI 0.579~0.675,P<0.001)。结论临床风险评分能帮助快速识别可能存在血小板高反应性的患者,从而指导抗血小板个体化治疗。
Objective To establish a clinical risk factor score for predicting platelet hyperreactivity after interventional therapy in patients with acute myocardial infarction and to guide clinical individualized antiplatelet therapy. METHODS: A total of 547 patients with acute myocardial infarction undergoing PCI at Fu Wai Hospital, Peking Union Medical College from January 2013 to December 2013 were enrolled. The general clinical data and postoperative thromboelastography were collected. Thromboelastography maximum clot strength (TEG-MAADP)> 47 mm was defined as the presence of platelet hyperreactivity. The risk factors associated with platelet hyperreactivity were screened by clinical indicators of common patients. The clinical indicators of P <0.05 in multivariate logistic regression analysis were included in the model of platelet hyperresponsiveness risk score, and the corresponding scores were assigned according to odds ratio (OR). Results Totally 230 patients (42.05%) had platelet reactivity in 547 patients. The TEG-MAADP value was higher than that in non-platelet hyperreactivity patients [(56.16 ± 6.57) mm vs (26.43 ± 13.88) mm, P <0.001). Univariate and multivariate logistic regression analysis found that elderly (> 75 years old), women with diabetes mellitus were independent risk factors of platelet hyperreactivity. According to the OR value weight to senior citizens (> 75 years) 3 points, women and diabetes each assigned 2 points, score range 0 to 7 points. The patients were divided into 3 groups according to the scores: 0 ~ 2, 3 ~ 5 and 6 ~ 7 groups. The results showed that there was significant difference in platelet reactivity between the three groups, and the platelet reactivity in the 0 ~ 2 group was lower than 3 ~ 5 and 6 ~ 7 [(37.79 ± 18.45) mm vs (50.04 ± 15.91) mm vs (56.50 ± 15.78) mm; P <0.001]. The receiver operating characteristic curve analysis showed that a score of> 2 points could effectively predict platelet hyperresponsiveness (area under the curve was 0.627, 95% CI 0.579-0.675, P <0.001). Conclusion The clinical risk score can help identify patients who may have platelet reactivity rapidly and thus guide the antiplatelet individualized treatment.