停用氯吡格雷后血小板功能“反跳”与缺血性脑卒中相关性研究  

Correlation Between Platelet Function Rebound and Ischemic Stroke After Discontinuation of Clopidogrel

作　　者：于颖慧 韩敬哲[1] 单敬[1] 赵云[1] 王红梅[1] 朱建国[1] Yu Yinghui;Han Jingzhe;Shan Jing;Zhao Yun;Wang Hongmei;Zhu Jianguo(Harrison International Peace Hospital,Hengshui,Hebei,China 053000)

机构地区：[1]哈励逊国际和平医院,河北衡水053000

出　　处：《中国药业》2018年第24期58-61,共4页China Pharmaceuticals

基　　金：河北省衡水市科技计划项目[15008]

摘　　要：目的分析停用氯吡格雷后血小板功能"反跳"与复发缺血性脑卒中的相关性。方法选择2014年9月至2015年11月于医院神经内科就诊服用氯吡格雷的缺血性脑卒中患者289例。监测患者开始服用氯吡格雷、因各种原因停用及停用后至少2个月的血小板功能,观察血小板功能"反跳"情况或主要终点事件的发生情况并分析其相关性。结果 289例患者中,氯吡格雷"抵抗"者30例(10. 38%),其中复发缺血性脑卒中8例(26. 67%);非氯吡格雷"抵抗"者259例(89. 62%),因各种原因停服氯吡格雷者153例(52. 94%),停药后复发率为26. 83%; 2个月后,停服患者血小板聚集率均不同程度增加,二磷酸腺苷-PL-11显示范围为45. 00%～60. 00%;缺血性脑卒中患者的血小板功能变化增加了复发风险; 76例患者出现血小板功能"反跳",其中33例复发缺血性脑卒中。血小板功能"反跳"和缺血性脑卒中存在显著相关性(P <0. 05)。结论缺血性脑卒中患者停用氯吡格雷后存在血小板功能"反跳",血小板功能变化会增加缺血性脑卒中复发的概率。合理应用抗血小板药物对缺血性脑卒中的预防作用仍需进一步关注。Objective To analyze the correlation between platelet function rebound and ischemic stroke after discontinuation of clopidogrel.Methods Totally 289 patients with ischemic stroke treated with clopidogrel in the Department of Neurology in our hospital from September 2014 to November 2015 were selected. The platelet function was monitored when patients started taking clopidogrel,after discontinuation of clopidogrel and at least 2 months after discontinuation of clopidogrel for various reasons. The rebound of platelet function or the occurrence of primary endpoint events were observed and their correlation was analyzed. Results Among 289 patients,30 patients( 10. 38%) were clopidogrel resistance,among which 8 patients( 26. 67%) had recurrent ischemic stroke. Totally 259 patients( 89. 62%)were clopidogrel non-resistant,153 patients( 52. 94 %) stopped taking clopidogrel for various reasons,and the recurrence rate was26. 83%. After 2 months,the platelet aggregation rate increased in different degrees in patients who stopped taking drugs. The display range of ADP-PL-11 was 45. 00%-60. 00%. The change of platelet function in patients with ischemic stroke increased the risk of recurrence. Totally 76 patients had rebound of platelet function,33 of them had recurrent ischemic stroke,there was a significant correlation between rebound of platelet function and ischemic stroke( P < 0. 05). Conclusion After discontinuation of clopidogrel,platelet function rebound may occur in patients with ischemic stroke,and the change of platelet function will increase the recurrence rate of ischemic stroke. The preventive effect of rational use of antiplatelet drugs on ischemic stroke still needs further attention.

关 键 词：缺血性脑卒中 氯吡格雷 血小板功能 停药后反跳 相关性 复发 

分 类 号：R969.3[医药卫生—药理学] R973.2[医药卫生—药学]