摘要
目的探讨缺血性卒中患者中氯吡格雷抵抗（clopidogrel resistance，CR）的危险因素。方法急性缺血性卒中患者服用氯吡格雷（75mg／a）10～14d后采用光比浊法测定血小板聚集率变化。根据血小板聚集率变化将病例分为CR组和氯吡格雷敏感（clopidogrel sensitivity，CS）组，比较两组的人口统计学和临床资料，并采用多变量logistic回归分析确定CR的独立危险因素。结果共纳入147例急性缺血性卒中患者，其中CR组42例（28．57％），CS组105例（71．43％）。CR组糖尿病（54．76％对11．43％；X^2=31．054，P=0．000）、既往短暂性脑缺血发作（transient ischemicattack，TIA）史（80．95％对26．67％；X^2=36．251，P=0．000）或经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）史（26．19％对3．81％；r=16．400，P=0．000）、服用钙通道阻滞药（calciumchannelblocker，CCB）（83．33％对54．29％；2／2=10．810，P=0．001）、血管紧张素转换酶抑制药（angiotensinconvertingenzymeinhibitor，ACEI）恤管紧张素受体阻滞药（angiotensin receptor blocker，ARB）（66．67％对42．86％；X^2=6．803，P=0．009）和质子泵抑制药（47．62％对14．29％；，=18．375，P=0．000）的患者比例以及血浆总胆固醇[（5．23±1．07）mmol／L对（4．60±1．11）mmol／L；t=3．121，P=0．002]、血糖浓度[（6．65±2．19）mmol／L对（5．43±1．15）mmol／L；t=3．442，P=0．001]和糖化血红蛋白水平[（6．40±1．42）％对（5．48±1．09）％；t=3．780，P=0．000]均显著高于CS组。多变量logistic回归分析显示，糖尿病[优势比（oddsratio，OR）13．711，95％可信区间（confidence interval，CI）1．667～112．784；P=0．015]、总胆固醇增高（OR2．828，95％CI1．574～5．080；P=0．001）、既往TIA史（OR16．627，95％CI4．691～58．934；P=0．000）以及长期服用CCB（OR4．147，95％CI 1．053～16．332；P=0．042）、ACEI／ARB（OR4．841，95％C11．539～15．231；P=0．007）为CR的独立危险因素。结论缺血性卒中患者的CR与多种因素有关，其中糖尿病、总胆固醇增高以及长期服用CCB和ACEI／ARB是CR的独立危险因素。
Objective To investigate the risk factors for clopidogrel resistance （CR） in patients with ischemic stroke. Methods Turbidimetry was used to measure the platelet aggregation rate changes after the patients with acute ischemic stroke taking 75 mg of clopidogrel per day for 10-14 days. The patients were divided into either a CR or a clopidogrel sensitivity （CS） group according to the platelet aggregation rate changes. The demographic and clinical data of both groups were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for CR. Results A total of 147 patients with acute ischemic stroke were included, 42 of them （28. 57% ） were in the RC group and 105 （71.43%） were in the CS group. The proportion of patients in diabetes （54. 76% vs. 11.43% ;x^2 = 31.054, P = 0. 000）, the history of transient ischemic attack （TIA） （80. 95% vs. 26. 67% ;X^2 =36. 251, P =0. 000） or percutaneous coronary intervention （PCI） （26. 19% vs. 3.81%;X^2 = 16. 400, P=0. 000）, taking calcium channel blocker （CCB） （83.33% vs. 54. 29% ;X^2 = 10. 810, P =0. 001）, angiotensin converting enzyme inhibitor （ACEI）/angioteusin receptor blocker （ARB） （66. 67% vs. 42. 86% ; X^2 = 6. 803, P = 0. 009）, and proton pump inhi＇bitor （47. 62% vs. 14. 29% ; X^2 = 18. 375, P = 0. 000） in the CR group, as well as the levels of plasma total cholesterol （TC）, glucose, and glycated hemoglobin were significantly higher than those in the CS group. Multivariate logistic regression analysis showed that diabetes （odds ratio [ OR] 13. 711, 95% confidence interval [ CI] 1. 667- 112. 784; P = 0. 015）, increased TC level （OR 2. 828, 95% CI 1. 574 - 5. 080; P = 0. 001）, previous history of TIA （OR 16. 627, 95% CI 4. 691 - 58. 934; P =0. 000）, and bag-term taking CCB （OR 4. 147, 95% CI 1.053 - 16. 332; P =0. 042）, and ACEUARB （OR 4. 841, 95% CI 1.539 - 15. 231; P =0. 007） were the indepeadent risk factors for CR. Condmlom CR in patients with ischemic stroke is associated with a variety of factors, in which diabetes, increased TC, as well as long-term taking CCB and ACEUARB are the independent risk factors for CR.
出处
《国际脑血管病杂志》
北大核心
2012年第6期423-427,共5页
International Journal of Cerebrovascular Diseases
基金
广东省科技计划项目（粤科计字[2008]146号）
关键词
缺血性卒中
氯吡格雷抵抗
血小板聚集
影响因素
Drug Resistance
Platelet Aggregation Inhibitors
Clopidogrel
Stroke
Brain Ischemia
Risk Factors
