[1]孟雪柔,潘文秋,赵 卫,等.TEG- PM与药物相关基因检测指导颅内动脉瘤支架植入后抗血小板聚集治疗的应用价值[J].介入放射学杂志,2023,32(07):627-631.
 MENG Xuerou,PAN Wenqiu,ZHAO Wei,et al.Clinical application value of TEG- PM and drug- related genetic testing in guiding against platelet aggregation therapy after stent implantation for intracranial aneurysms[J].journal interventional radiology,2023,32(07):627-631.
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TEG- PM与药物相关基因检测指导颅内动脉瘤支架植入后抗血小板聚集治疗的应用价值()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
32
期数:
2023年07
页码:
627-631
栏目:
神经介入
出版日期:
2023-07-31

文章信息/Info

Title:
Clinical application value of TEG- PM and drug- related genetic testing in guiding against platelet aggregation therapy after stent implantation for intracranial aneurysms
作者:
孟雪柔 潘文秋 赵 卫 易根发 李 刚 赵芝敏 张晓东
Author(s):
MENG Xuerou PAN Wenqiu ZHAO Wei YI Genfa LI Gang ZHAO Zhimin ZHANG Xiaodong.
Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province 650032, China
关键词:
【关键词】 颅内动脉瘤 血栓弹力图血小板图 血小板内皮聚集受体1基因 细胞色素 P 450 酶 2 C 19基因 抗血小板聚集治疗
文献标志码:
A
摘要:
【摘要】 目的 探讨颅内动脉瘤患者行支架植入术后分别在血栓弹力图血小板图(thromboelasto- graphy- platelet mapping,TEG- PM)检测与药物相关抵抗基因检测指导下的抗血小板聚集治疗用药的安全性及有效性。方法 纳入2021年1月至2022年8月昆明医科大学第一附属医院收治的颅内动脉瘤患者65例,所有患者均行阿司匹林及氯吡格雷相关基因检测,并于服用抗血小板药物后行TEG- PM。将患者随机分为A组33例,B组32例。A组在药物相关基因检测指导下行抗血小板聚集治疗,B组在TEG- PM指导下行抗血小板聚集用药。比较两组术后缺血性并发症及出血性并发症发生率。结果 缺血性并发症B组0例,A组2例(RR=0.492,95%CI:0.383~0.632,χ2=0.485,P=0.468),A组2例患者分别于用药后3.4个月及1.6个月出现缺血性并发症。出血性并发症A组1例,B组3例(RR=0.302,95%CI:0.303~3.069,χ2=0.300,P=0.584);A组中1例患者于术后4.33个月出现牙龈出血,B组3例患者中,2例于术后2.2个月及1.6个月无明显诱因出现皮肤散在片状青紫, 1例于术后2.3个月出现黑便,完善相关检查发现消化道溃疡。结论 颅内动脉瘤行支架植入术后在TEG- PM及药物相关基因检测下指导抗血小板聚集治疗安全可行,临床应用时应据患者个体化选择,并检测其指标变化,及时调整用药。

参考文献/References:

[1] 吴桥伟,李 立,邵秋季,等. Pipeline Flex血流导向装置治疗颅内复杂动脉瘤的安全性及短期疗效[J]. 中华介入放射学电子杂志, 2020, 8:28- 32.
[2] 李淦诚,张 炘,范海燕,等. 支架辅助弹簧圈栓塞颅内破裂动脉瘤临床分析[J]. 介入放射学杂志, 2020, 29:439- 443.
[3] 张荣举,王 君,吕 斌,等. Neuroform EZ支架治疗颅内动脉瘤安全有效性单中心观察[J]. 介入放射学杂志, 2020, 29:228- 231.
[4] Deng Q, Feng W, Hai H, et al. Evaluation of the safety and efficacy of a Pipeline Flex embolization device for treatment of large, wide- necked intracranial aneurysms[J]. J Interv Med, 2018, 1: 229- 233.
[5] Deng Q, Feng WF. Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms[J]. J Interv Med, 2020, 3: 45- 48.
[6] 耿介文,翟晓东,吉 喆,等. 中国颅内未破裂动脉瘤诊疗指南2021[J]. 中国脑血管病杂志, 2021, 18:634- 664.
[7] 颅内动脉瘤抗血小板治疗中国专家共识编写组.颅内动脉瘤抗血小板治疗中国专家共识[J]. 国际脑血管病杂志, 2021, 29:646- 653.
[8] 中国医师协会神经介入专业委员会出血性脑血管病神经介入专业委员会(学组),中国医师协会神经外科医师分会神经介入专业委员会,中国医师协会介入医师分会神经介入专业委员会.血流导向装置治疗颅内动脉瘤的中国专家共识[J]. 中华神经外科杂志, 2020, 36:433- 445.
[9] Vadasz D, Sztriha LK, Sas K, et al. Aspirin and clopidogrel resistance: possible mechanisms and clinical relevance. Part I: concept of resistance[J]. Ideggyogy Sz, 2012, 65: 377- 385.
[10] Flechtenmacher N, Kammerer F, Dittmer R, et al. Clopidogrel resistance in neurovascular stenting: correlations between light transmission aggregometry, verifynow, and the multiplate[J]. AJNR Am J Neuroradiol, 2015, 36: 1953- 1958.
[11] 邵 波,陈 钰,陈慧慧,等. 血栓弹力图对支架辅助栓塞颅内未破裂动脉瘤患者阿司匹林和氯吡格雷双联抗血小板治疗后疗效的监测价值[J]. 中国现代医生, 2022, 60:40- 43.
[12] Javed K,Unda SR,Holland R,et al. Thromboelastography(TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion[J]. Interv Neuroradiol, 2022, 28: 219- 228.
[13] 张 亮,宋 英,韩 光,等. TEG检测对颅内动脉瘤破裂支架辅助栓塞术患者围术期抗凝药物应用的临床价值[J]. 山东医药, 2020, 60:65- 67.
[14] Li Y, Zhang X, Guo Z, et al. Standard vs. modified antiplatelet therapy based on thromboelastography with platelet mapping for preventing bleeding events in patients undergoing stent- assisted coil for a ruptured intracranial aneurysm[J]. Front Neurol, 2020, 11: 615829.
[15] McTaggart RA, Choudhri OA, Marcellus ML, et al. Use of thromboelastography to tailor dual- antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the pipeline embolization device[J]. J Neurointerv Surg, 2015, 7: 425- 430.
[16] 巢 青,束汉生,王 昊,等. 血栓弹力图在支架辅助颅内破裂动脉瘤栓塞术后抗凝治疗中的应用[J]. 蚌埠医学院学报, 2018, 43:1003- 1006.
[17] 张翔圣,张 鑫,张庆荣,等. 血栓弹力图对支架辅助颅内栓塞动脉瘤不同剂量抗血小板聚集药物疗效的初步评价[J]. 中国脑血管病杂志, 2015, 12:130- 133, 159.
[18] 张学贤.阿司匹林、氯吡格雷抵抗基因在颅内动脉瘤支架治疗中的应用[D]. 云南:昆明医科大学, 2021.
[19] 刘 岩,李丽琼,曲 颖,等. 血小板内皮聚集受体1基因多态性与阿司匹林抵抗及心血管事件发生相关性研究[J]. 临床军医杂志, 2021, 49:532- 535.
[20] 张涵煦,向 倩,谢秋芬,等.细胞色素P450酶2C19基因多态性的氯吡格雷个体化用药临床研究分析[J]. 中国临床药理学杂志, 2022, 38:1274- 1277.
[21] 吴中华.血栓弹力图指导下的三联抗血小板治疗在颅内外支架植入中应用的安全性[D]. 苏州:苏州大学, 2018.
[22] 赖开生,靳文勋,江 慧,等. CYP2C19基因多态性在指导抗血小板药物选择治疗中的意义[J]. 河北医学, 2022, 28:1325- 1331.
[23] Nishi H, Nakahara I, Matsumoto S, et al. Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy[J]. J Neurointerv Surg, 2016, 8: 949- 953.
[24] Craft RM, Chavez JJ, Bresee SJ, et al. A novel modification of the thrombelastograph assay, isolating platelet function, correlates with optical platelet aggregation[J]. J Lab Clin Med, 2004, 143: 301- 309.
[25] 唐 婉,林晓光. 急性脑梗死患者血栓弹力图与CYP2C19基因多态性对氯吡格雷疗效评价的关系[J].心脑血管病防治,2022, 22:55- 57.
[26] 蒋业清,鲁 刚,葛 亮,等. 颅内动脉瘤介入治疗相关症状性缺血并发症分析[J]. 介入放射学杂志, 2021, 30:112- 117.
[27] Nishido H,Piotin M,Bartolini B,et al. Analysis of complications and recurrences of aneurysm coiling with special emphasis on the stent- assisted technique[J]. AJNR Am J Neuroradiol, 2014, 35: 339- 344.
[28] McLaughlin N, McArthur DL, Martin NA. Use of stent- assisted coil embolization for the treatment of wide- necked aneurysms: a systematic review[J]. Surg Neurol Int, 2013, 4: 43.
[29] Heller RS, Dandamudi V, Lanfranchi M, et al. Effect of antiplatelet therapy on thromboembolism after flow diversion with the pipeline embolization device[J]. J Neurosurg, 2013, 119: 1603- 1610.
[30] Ge H, Yang H, Ren H, et al. Association of thrombelastographic parameters with complications in patients with intracranial aneurysm after stent placement[J]. World Neurosurg, 2019, 127: e30- e38.


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备注/Memo

备注/Memo:
(收稿日期:2022- 11- 22)
(本文编辑:新 宇)
更新日期/Last Update: 2023-07-31