缺血性卒中患者氯吡格雷抵抗的危险因素：前瞻性病例系列研究  

Risk factors for dopidoel resistance in patients with ischemic stroke： a prospective case series study

作　　者：石红婷[1] 周伯荣[1] 邓燕华[1] 关海涛[1] 刘子凡[1] 王融[2] 

机构地区：[1]广州医学院第三附属医院神经内科,510150 [2]广州医学院第三附属医院检验科,510150

出　　处：《国际脑血管病杂志》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）

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．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 is

关 键 词：缺血性卒中 氯吡格雷抵抗 血小板聚集 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]