新型冠状病毒感染强化治疗中血小板聚集诱导剂最佳浓度的选择与确定

A. Marochkov, A. Lipnitski, A.G. Starovoitov, V. Dazortsava, V. Livinskaya
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摘要

在新型冠状病毒感染治疗期间,患者血小板功能的变化可以通过血小板聚集法来确定。目标。目的:探讨血小板聚集的最佳诱导剂及其在COVID-19患者强化治疗中的预后意义。材料和方法。1组34例新型冠状病毒感染患者,2组30例健康女性。采用AP2110浊度分析仪(SOLAR)进行血小板聚集研究。当ADP诱导剂剂量为0.3 μg/ml时,1组患者的聚集曲线下面积显著增大(69.1 (27.3;164.4)单位与55.3 (31.5;2组68.2个单位,p<0.001)。ADP诱导剂浓度分别为1.25和2.5 μg/ml,肾上腺素诱导剂浓度分别为2.5和5 μM时,COVID-19感染患者曲线下面积较2组显著降低。根据Hosmer-Lemeshov标准的聚集曲线下面积被发现是重症监护病房死亡的独立预测因子(卡方=5.074,当ADP为0.3 μg/ml时p=0.06;卡方=15.121,当ADP为0.6 μg/ml时p=0.057)。结论。ADP诱导剂、肾上腺素诱导剂和胶原诱导剂对血小板聚集的对比分析表明,在新型冠状病毒感染患者中,应根据ADP诱导剂在0.3和0.6 μg/ml剂量下获得的适应症来判断凝血失衡程度。
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SELECTION AND DETERMINATION OF THE OPTIMAL CONCENTRATION OF THE PLATELET AGGREGATION INDUCER IN INTENSIVE THERAPY OF PATIENTS WITH COVID-19 INFECTION
The change in platelet function that occurs in patients during treatment for a new coronavirus infection can be determined using the platelet aggregation method. Objectives. To determine optimal inducer of platelet aggregation and to assess its prognostic significance in intensive therapy of patients with COVID-19 infection. Material and methods. 34 patients with new coronavirus infection were included in group 1, and 30 healthy women were included in group 2. The study of platelet aggregation was carried out by the turbidimetric method with AP2110 analyzer (SOLAR, Results. The area under the aggregation curve was statistically significantly greater in patients in group 1 when using an ADP inducer at a dose of 0.3 μg/ml (69.1 (27.3; 164.4) unit in comparison with 55.3 (31.5; 68.2) units in group 2, p<0.001). When using an ADP inducer in high concentrations of 1.25 and 2.5 μg/ml and an adrenaline inducer in concentrations of 2.5 and 5 μM, the area under the curve in patients with COVID-19 infection was statistically significantly lower compared to group 2. The area under the aggregation curve according to the Hosmer-Lemeshov criterion has been found to be an independent predictor of death in the intensive care unit (Chi-square=5.074, p=0.06 for ADP 0.3 μg/ml and Chi square=15.121, p=0.057 for ADP 0.6 μg/ml). Conclusions. A comparative analysis of platelet aggregation using inducers of ADP, adrenaline and collagen has shown that in patients with new coronavirus infection, the degree of coagulation imbalance should be determined according to the indications obtained with an ADP inducer at a dose of 0.3 and 0.6 μg/ml.
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