Objective: To evaluate the value of a new platelet function test PFA P2Y (PFA-200) in monitoring clopidogrel treatment for cardiovascular disease in elderly patients.
Methods: Fifty-six elderly patients receiving clopidogrel therapy in the Department of Cardiology of General Hospital of PLA from March to August in 2016 and 85 healthy volunteers were recruited for analysis. All the subjects underwent PFA P2Y, LTA (light transmittance aggregometry) and TEG (Thromboelastograph) tests, and Spearman correlation coefficients were used to test the associations between test results. The agreement among the 3 platelet function test methods was assessed using Cohen's kappa coefficient.
Results: Correlation coefficient (r) was -0.701 (P<0.001) between PFA P2Y and LTA, and 0.475 (P<0.001) between PFA P2Y and TEG. The agreement was 75% between PFA P2Y and LTA and 67.9% between PFA P2Y and TEG. The κ value was 0.434 (P=0.001) between PFA P2Y and LTA and 0.242 (P=0.046) between PFA P2Y and TEG. With ADP-induced maximum platelet aggregation rate of LTA >50% as the laboratory clopidogrel resistance, the cut-off value of PFA P2Y was 119 s (AUC=0.733) with a sensitivity of 75.6% and a specificity of 73.3%.
Conclusion: PFA P2Y has a moderate correlation and agreement with LTA, but has a poor correlation and agreement with TEG. PFA P2Y can be useful for assessing the effects of clopidogrel therapy and the association of the cut-off value (119 s) with the long-term clinical ischemic events needs be confirmed in further study.
目的: 通过与两种常见的血小板功能检测方法的比较，评价血小板功能分析仪PFA-200的一种新的检测方法监测老年心血管病患者氯吡格雷治疗的应用价值。
方法: 选取2016年3月~8月解放军总医院心内科病房服用氯吡格雷的老年心血管病患者56例，并征集健康志愿者85例，使用PFA P2Y、光学比浊法（LTA）和血栓弹力图（TEG）同时检测所有受试者的血小板功能，评价PFA P2Y分别与LTA和TEG的相关性、符合率。
结果: PFA P2Y vs LTA（r=-0.701，P < 0.001）；PFA P2Y vs TEG（r=0.475，P < 0.001）。PFA P2Y vs LTA的符合率为75%，κ=0.434（P=0.001）；PFA P2Y vs TEG的符合率为67.9%，κ=0.242（P=0.046）。以LTA的MARADP（ADP诱导的最大血小板聚集率）>50%作为实验室氯吡格雷抵抗标准，作ROC曲线，得PFA P2Y的cut-off值为119s（AUC 0.733，灵敏度75.6%，特异度73.3%）。
结论: PFA P2Y与LTA具有较好的相关性和符合率，与TEG的相关性和符合率较差。PFA P2Y可用于监测老年心血管病患者氯吡格雷治疗，cut-off值为119 s，但与临床缺血事件的相关性还有待进一步确认和研究。