| Background and objective:With the development of the society,the aging of the population and the change of eating habits,cardiovascular disease is gradually becoming one of the main causes of death in China.Platelets are one of the important components of physiological coagulation in the body.In the pathogenesis of acute coronary syndrome(acute coronary syndrome,ACS),platelet activation is a key link and a major cause of ischemic complications.Because of this,antiplatelet therapy is the cornerstone of prevention and treatment of acute ischemic events throughout the treatment of ACS.ACS in patients with percutaneous coronary interention(percutaneous coronary intervention,PCI),in spite of stent thrombosis(stent thrombosis ST)is a rare event,but it is a serious or even fatal complications,mortality is higher.Dual antiplatelet therapy is the most advanced treatment to prevent ischemic adverse events in ACS patients after PCI.However,a significant proportion of patients do not respond adequately to universe antiplatelet therapy.These nonresponders are at increased risk for stent thrombosis,stroke,and other ischemic complications.platelet function(PF)tests can identify these patients,enabling doctors to provide personalized and alternative treatment strategies.Therefore,this study based on the PAR(platelet aggregation rate,PAR)up to standard or not the related influence factors analysis,further testing in patients taking clopidogrel CYP2C19 genotype,and follow-up of patients with PCI postoperative incidence of major cardiovascular events a month,what are the general factors influencing on platelet function test,PAR is related to genotypes,and the relationship between the occurrence of adverse events.It provides basis for clinical rational selection of antiplatelet drugs.Methods:A total of 201 patients who were diagnosed with coronary heart disease in the department of cardiology of our hospital between January 2018 and October 2018 and underwent coronary angiography and were tested for platelet aggregation rate after postoperative dual anti-load dose therapy were retrospectively selected.According to the clinical significance of platelet aggregation rate,>50%was the group whose adp-induced aggregation rate failed to reach the standard,the group whose adp-induced aggregation rate was<50%,the group whose adp-induced aggregation rate failed to reach the standard,the group whose adp-induced aggregation rate failed to reach the standard,the group whose adp-induced aggregation rate failed to reach the standard,and the group whose adp-induced aggregation rate failed to reach the standard.According to the genotype test results,the patients were divided into fast metabolism group and moderate-slow metabolism group.Are obtained through access to medical records in the hospital records of patients general data,laboratory examination as a result,the contrast between the two groups of patients with gender,age,smoking history,history of drinking,whether to have hypertension(and the influence of hypertension of different grading),diabetes(with or without),different diagnoses(acute st-elevation myocardial infarction,acute non ST segment elevation myocardial infarction and unstable angina),antiplatelet strategies are clopidogrel,or on behalf of Greg lowe,hemoglobin,hematocrit,erythrocyte press),serum creatinine,aspertate aminotransferase and Alt data involved in the laboratory results,parameters,such asStatistical analysis was performed.Measurement data,such as age,platelet count,and LDL cholesterol,were normally distributed,and were expressed by mean square root standard deviation.Counting data such as gender,smoking history,history of hypertension and the occurrence of various events during the follow-up were expressed in proportion.T-test and chi-square test were used respectively.After comparing statistically significant variables between groups,further Logistic regression analysis was performed.P<0.05 indicated statistical difference.Results:(1)Gender(χ~2=3.944,p<0.05),dual antibody regimen(χ~2=9.649,p<0.05),uric acid level(t=2.345,p<0.05),platelet volume distribution width(t=3.493,p<0.05)were significantly different in ADP-induced PAR between the standard group and the non-standard group.There was no significant difference between the AA-induced PAR of the standard group and the non-standard group.(2)Different dual antibody regiments(P<0.05,95%CI 3.254-853.787),gender(P<0.05,95%CI 0.002-0.294),uric acid level(P<0.05,95%CI 1.010-1.050)were independently correlated with ADP-induced PAR,while other indicators were not independently correlated with PAR.(3)In 110 patients undergoing genotyping detection,the occurrence rate of allele deletion was the same as that of previous studies,with the fast metabolism type accounting for 53.64%and the moderate and slow metabolism type accounting for46.36%.The ADP-induced PAR was significantly different between the fast metabolism group and the moderate and slow metabolism group(t=-2.072,P<0.05).(4)The ADP-induced PAR was significantly different in the occurrence of clinical adverse events(χ~2=4.21,P<0.05)after one-month follow-up of 201 patients after PCI compared with the PAR and genotype detection.Conclusion:(1)Different anti-platelet strategies have different effects on ADP-induced PAR,and ticagrelor can achieve a lower ADP-induced PAR.(2).Gender is an independent factor of whether the ADP-induced PAR meets the standard,and the PAR may be higher in women.However,due to the disease characteristics of female coronary heart disease,it may be more meaningful to detect platelet function in women receiving anti-platelet therapy.(3).Uric acid level is an independent risk factor for ADP-induced platelet aggregation.The higher the uric acid level,the lower the PAR.(4)ADP-induced PAR may be more likely to reach the target in the fast metabolome,while substandard PAR is more likely to bring clinical ischemic events. |
