儿童先心病伴高危血栓风险术后阿司匹林使用前血小板聚集率基础状态及相关影响因素探讨

鲁中原; 杨菊先; 杨帆; 周宇子; 姜亚洲; 魏嵬; 沈瑞环; 王旭

doi:10.12125/j.chj.202101093

儿童先心病伴高危血栓风险术后阿司匹林使用前血小板聚集率基础状态及相关影响因素探讨

Basic status and influencing factors of platelet aggregation rate before aspirin initiation in pediatric congenital heart disease with high risk of thrombosis

摘要

摘要:
目的通过对高危血栓风险先心病儿童在术后阿司匹林初次使用前血小板聚集率的测定，探讨此类人群血小板聚集率的基础状态及主要影响因素，为药物效果正确评价提供前期基础。
方法纳入对象为2020年4月～2020年9月在中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿外科中心住院手术的所有先心病儿童，具有高危血栓风险并且签订知情同意书，在其手术后阿司匹林初次使用前进行血小板聚集率（PAG-AA）测定，了解此类人群的血小板基础聚集率状态。并通过单因素及多因素分析，探讨主要影响因素。
结果最终满足入选条件进行基础PAG-AA检测患者共196例（男，116），年龄13个月（12天～6岁），体质量（10.2 ± 4.9）kg。基础状态的PAG-AA中位值为20.7%(1.3%～86.5%)，其中67.3% PAG-AA均处于低下状态（<55%），47.9% PAG-AA处于严重低下状态（≤20%）。体外循环手术患者术后基础PAG-AA显著低于非体外循环患者（31 ± 27 vs. 58 ± 28，P<0.05）；体外循环术后3天内检测者显著低于3天后检测者（26 ± 26 vs. 49 ± 26，P<0.01）；紫绀病人显著高于非紫绀病人（39 ± 27 vs. 26 ± 26, P<0.05）。多因素回归分析显示体外循环与否以及术后检测时间是影响先心病儿童基础PAG-AA检测值的主要影响因素，紫绀并无显著影响。
结论高危血栓风险先心病儿童在术后阿司匹林初次使用前血小板聚集率的基础值波动范围较大，但大多数均位于正常值以下，严重低下者占比近50%。其主要影响因素为是否行体外循环以及术后检测时点。体外循环术后3天内PAG-AA显著减低，是否紫绀对基础状态测定值无显著影响。评价阿司匹林的药物效果应该以体外循环影响基本结束后的PAG-AA结果为参考基准，建议以手术3天后为宜。

Abstract:
AIM To explore the basic status and main influencing factors of the platelet aggregation rate by measuring the platelet aggregation rate before the first use of postoperative aspirin in children with congenital heart disease at high risk of thrombosis, so as to provide a preliminary basis for the accurate evaluation of aspirin effect.
METHODS A prospective cohort study was conducted in our Pediatric Cardiac Center. Congenital heart disease children at high risk of thromboembolism who were hospitalized for surgery from April 2020 to September 2020 were included in this study. An informed consent was signed and the arachidonic acid induced platelet aggregation rate (PAG-AA) was measured just before the first dose of aspirin after the operation. Thus, the basic status of PAG-AA values for this population were obtained. Through the single factor and multiple factors analysis, the influencing factors were investigated.
RESULTS A total of 196 patients met the inclusion criteria and signed informed consent (116 males; median age of 13 months, 13 days～6 years; and mean weight of 10.2 ± 4.9 kg). The median PAG-AA in basal state was 20.7% (1.3%-86.59%), with 67.3% distributed under 55% and 47.9% under 20%. Patients undergoing cardiopulmonary bypass had a significantly lower basic PAG-AA than those without cardiopulmonary bypass (31 ± 27 vs. 58 ± 28, P<0.05) and the basic PAG-AA values within 3 days after the cardiopulmonary bypass were significantly lower than those 3 days after cardiopulmonary bypass (26 ± 26 vs. 49 ± 26, P<0.01). Cyanosis patients had an obvious higher basic PAG-AA than patients without cyanosis (39 ± 27 vs. 26 ± 26, P<0.05). Multivariate regression analysis showed that cardiopulmonary bypass and the time point of testing after the operation were the main factors affecting the basic PAG-AA values in children with congenital heart disease, and cyanosis had no significant influence.
CONCLUSION The basic value of platelet aggregation rate after operation in children with congenital heart disease at high risk of thromboembolism fluctuates widely, with the majority below normal and nearly 50% of them in severely low state. The main influencing factors are cardiopulmonary bypass and the time point of testing. PAG-AA is significantly lower when the test is done within 3 days after the cardiopulmonary bypass and cyanosis has no significant impact on the baseline value. PAG-AA values 3 days after the cardiopulmonary bypass are recommended for accurate evaluation of the effect of aspirin.

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