南方医科大学学报

南方医科大学学报 ›› 2014, Vol. 34 ›› Issue (03): 434-.

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流式细胞术检测VASP的磷酸化程度可监测氯吡格雷抵抗

李广华，罗燕飞，罗盈，林婷，范小斌，梁玲，谢红东，黄锦维   

  • 出版日期:2014-03-20 发布日期:2014-03-20

Feasibility of monitoring clopidogrel resistance with flow cytometric analysis of platelet
vasodilator stimulated phosphoprotein phosphorylation

  • Online:2014-03-20 Published:2014-03-20

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摘要： 目的评价流式细胞术检测血小板血管扩张剂刺激磷蛋白（VASP）的磷酸化程度对监测氯吡格雷抵抗的可行性。方法以
17例健康人作为对照组，分别采用传统光学比浊法检测血小板聚集率（PAR）和流式细胞术检测血小板内VASP磷酸化程度（换
算成血小板反应指数PRI），再检测20例冠心病患者服药前及服药后（联合服用氯吡格雷和阿司匹林）的血小板聚集率及血小板
反应指数（PRI），进行统计学分析。结果服药前病例组血小板反应指数PRI=（89.45±5.22）%与对照组PRI=（86.58±4.35）%相比
无差异（P>0.05），服药后病例组血小板反应指数PRI=（67.66±19.77）%与服药前相比有差异（P<0.05）。经流式细胞术
VASP-P法检测共发现6例氯吡格雷抵抗，抵抗率为30%，比光学比浊法10%的抵抗率更敏感。结论①流式细胞术检测血小板
VASP-P法是一种更特异的检测氯吡格雷抵抗的可靠方法；②冠心病患者联合服用氯吡格雷和阿司匹林治疗后氯吡格雷的抵
抗率为30%。

Abstract: Objective To evaluate the feasibility of monitoring clopidogrel resistance with flow cytometric analysis of platelet
vasodilator stimulated phosphoprotein (VASP) phosphorylation. Methods Twenty patients with coronary heart disease
(CHD) and 17 healthy volunteers were examined for platelet aggregation rate and phosphorylation of VASP (calculated as
platelet reactivity index, PRI) using traditional optical nephelometry and flow cytometry before and after concurrent therapy
of clopidogrel and aspirin. Results No significant differences were found in PRI between CHD group and healthy control
group [(89.45±5.22)% vs (86.58±4.35)%] before treatment. The PRI in CHD group was significantly lowered after treatment to
(67.66±19.77)% (P<0.05). Clopidogrel resistance was found in 6 (30%) cases in CHD group by flow cytometric analysis, which
showed a higher sensitivity than optical nephelometry (10%). Conclusion Flow cytometric analysis of VASP phosphorylation
is a more reliable test to specifically evaluate clopidogrel resistance.