血栓弹力图评价大动脉粥样硬化性脑梗死患者氯吡格雷抗栓效果和预测血管事件的价值  

Role of thrombelastography in assessing antithrombotic efficacy of clopidogrel and predicting vascular events in patients with LAA

作　　者：倪贵华[1] 梁晨 赵卫东[1] 孙波[1] 倪小宇[1] 田向阳[1] 陈林芳[1] NI Gui-hua LIANG Chen ZHAO Wei-dong et al(Department of Neurology, Huai＇an First Hospital, Nanjing Medical University, Huai＇an 223300, J iangsu Province, Chin)

机构地区：[1]南京医科大学附属淮安第一医院神经内科,223300 [2]新疆建设兵团第七师医院神经科

出　　处：《中华老年心脑血管病杂志》2017年第5期513-516,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨血栓弹力图(TEG)评价急性大动脉粥样硬化性脑梗死患者氯吡格雷的抗栓效果及预测缺血性血管事件复发的价值。方法连续性纳入住院治疗的急性大动脉粥样性脑梗死患者268例,氯吡格雷治疗≥5d后,用TEG测血小板反应性,分为敏感组192例和抵抗组76例。采用多因素logistic回归分析氯吡格雷抵抗的相关因素,随访3个月内缺血性事件发生情况,用Cox回归模型分析缺血性血管事件复发的影响因素。结果抵抗组糖尿病明显高于敏感组,高体质量指数(>26kg/m^2)明显低于敏感组(P<0.05)。logistic回归分析,高体质量指数(OR=2.262,95%CI:1.129~4.531,P=0.021),糖尿病(OR=2.494,95%CI:1.211~5.135,P=0.013)与氯吡格雷抵抗相关。Cox回归分析,年龄(HR=1.048,95%CI:1.006~1.093,P=0.026)、氯吡格雷抵抗(HR=2.355,95%CI:1.067~5.201,P=0.034)和糖尿病(HR=1.591,95%CI:1.021~3.481,P=0.029)是血管性事件复发的危险因素。结论 TEG能评价大动脉粥样硬化性脑梗死患者的血小板反应性和预测血管性事件复发风险。Objective To study the role of thrombelastography in assessing antithrombotic efficacy of clopidogrel and predicting vascular events in patients with ischemic stroke due to large artery atherosclerosis.Methods Two hundred and sixty-eight patients with ischemic stroke due to acute large artery atherosclerosis admitted to our hospital were included in this study.After they received antithrombotic therapy with clopidogrel for≥5days,their platelet reactivity was assayed by thrombelastography.The patients were divided into clopidogrel sensitive group（n=192）and clopidogrel resistant group（n=76）.Independent factors for clopidogrel resistance were analyzed by multivariate logistic regression analysis.The patients were followed up for 3 months,during which ischemic vascular events were recorded.Factors influencing recurrent ischemic vascular events were analyzed by multivariate Cox proportional hazards regression analysis.Results The prevalence of diabetes and BMI（26 kg/m2）were significantly different between the two groups.Multivariate logistic regression analysis showed that BMI（26kg/m2）and diabetes were related with clopidogrel resistance（P〈0.05）.Cox proportional hazards regression analysis showed that age,clopidogrel resistance and diabetes were the independent risk factors for recurrent ischemic vascular events（HR=1.048,95%CI：1.006-1.093,P=0.026;HR=2.355,95%CI：1.067-5.201,P=0.034;HR=1.591,95%CI：1.021-3.481,P=0.029）.ConclusionThrombelastography can assess the platelet reactivity and predict the risk of ischemic vascular events in patients with ischemic stroke due to large artery atherosclerosis.

关 键 词：血栓弹力描记术 动脉粥样硬化 脑梗死 糖尿病 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]