老年脑梗死患者氯吡格雷抵抗的影响因素  

Influencing factors of clopidogrel resistance in elderly patients with cerebral infarction

作　　者：吴武姿[1] 熊靓[2] 何力鹏[1] 彭小丹[1] 李小秋[2] 

机构地区：[1]武警江西总队医院内三科,江西南昌330030 [2]武警江西总队医院内一科,江西南昌330030

出　　处：《武警后勤学院学报（医学版）》2015年第7期543-545,553,共4页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨老年脑梗死患者氯吡格雷抵抗(clopidogrel resistance,CR)的影响因素。【方法】85例老年脑梗死患者为研究对象,将血小板聚集抑制率低于10%的患者纳入抵抗组,超过10%的患者纳入对照组,比较两组患者临床资料的差异,分析引起CR的危险因素。【结果】26例患者出现CR,发生率为30.6%,均纳入抵抗组,其余59例患者纳入对照组。单因素分析发现两组患者并发2型糖尿病比例、LDL-C水平及大面积脑梗死差异明显。多因素Logistic回归分析发现,2型糖尿病(OR=2.203,P<0.05)、LDL-C水平(OR=1.715,P<0.05)是引起CR的独立危险因素,而大面积脑梗死并非影响因素(OR=1.087),无统计学意义(P>0.05)。随访12个月,CR组短暂性脑缺血发作(transient ischemic attack,TIA)和再次脑梗死发生率分别为44.0%和24.0%,对照组TIA和再次脑梗死发生率分别为17.9%和8.9%,抵抗组不良脑血管事件复发率显著高于对照组(P<0.05)。【结论】部分老年脑梗死患者会出现CR,糖尿病、LDL-C升高是其独立危险因素,这部分患者容易再次出现不良脑血管事件。[Objective] To explore the influencing factors of clopidogrel resistance （CR）in elderly patients with cerebral infarction （CI）. [Method] Eighty-five elderly patients with CI were investigated. There were two grous： CR group （platelet agglutination inhibition rate lower than 10% ） and control group （platelet agglutination inhibition rate higher than 10% ）. Clinical data in the two groups were compared and logistic regression analysis was performed for the risk factors of CR. [ Results]There were 26 cases with CR and the occurrence rate of CR was 30.6%. These 26 patients were divided into CR group and the other 59 cases were in control group. Single factor analysis showed that the proportion of intercurrent type 2 diabetes mellitus, LDL-C levels and massive cerebral infarction were obviously different between two groups （/9〈0.05）. Logistic regression analysis revealed that type 2 diabetes mellitus （OR=2.203, P〈 0.05）and the level of LDL-C （0R=1.715, P〈0.05） were independent risk factors of CR and the massive cerebral infarction was not a risk factor （ OR= 1.087, P〉0.05） in statistics. After 1 year following up, the incidence rates of transient ischemic attack （TIA） and CI in CR group were 44.0% and 24.0% while 17.9% and 8.9% in control group. The recurrence of cerebrovascular adverse events in CR group were higher than that in control group （P〈0.05）. [Conclusion] CR may occur in some elderly patients with CI, and type 2 diabetes mellitus and rising LDL-C level were its independent risk factors. Cerebrovascular adverse events are easy to recur in these patients.

关 键 词：脑梗死 老年 氯吡格雷抵抗 

分 类 号：R541.4[医药卫生—心血管疾病]