双抗患者缺血性脑卒中复发与血小板高反应性的相关性研究  

Recurrence of ischemic stroke associated high on-treatment platelet reactivity: correlation study

作　　者：陈梦萦[1] 展淑琴[1] 车璐 曹军霞 张晓冬 石金铭 巩付华 郑少微[1] CHEN Mengying;ZHAN Shuqin;CHE Lu(The Department of Second Affiliated Hospital of Xi’an Jiaotong University,Xian 710004,China)

机构地区：[1]西安交通大学第二附属医院神经内科,陕西西安710004

出　　处：《中风与神经疾病杂志》2019年第4期296-299,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金项目(No.81070999);陕西省社会发展科技攻关项目(No.2016SF-020);西安交通大学第二附属医院新技术新疗法(No.2018-16;No.2010-22);西安交通大学第二附属医院人才培养专项科研基金科技骨干项目[No.RC(GG)201109];中央高校基本科研业务费专项资金资助(西安交通大学;No.xjj2014153;No.2009-95)

摘　　要：目的 探讨双联抗血小板治疗患者缺血性脑卒中复发与血小板高反应性及基因多态性的关系。方法 87例急性缺血性脑卒中患者被纳入,随访6个月,比较复发组和对照组血栓弹力图参数及CYP2C19基因多态性。结果 复发组2型糖尿病(69. 2%vs 37. 8%,χ~2=4. 46,P=0. 04)的发生比例较对照组高。复发组MA_(ADP)水平显著增高(52. 43±11. 80 vs 42. 17±26. 44,P=0. 02)、ADP%水平显著降低(22. 55±25. 60 vs 42. 17±26. 44,P=0. 01),两组MA_(AA)和AA%比较差异无统计学意义。MA_(ADP)的ROC曲线下面积为0. 749,47. 15是曲线临界点,此时灵敏度(84. 6%)和特异度(68. 9%)均较好。多因素Logistic回归模型显示MA_(ADP)与2型糖尿病(OR=1. 077,95%CI=1. 014～1. 144,P=0. 016; OR=3. 791,95%CI=1. 006～14. 285,P=0. 049)均为缺血性脑卒中复发的独立危险因素。结论 MA_(ADP)对缺血性脑卒中复发的诊断有意义,47. 15是MA_(ADP)预测复发的最佳临界值。MA_(ADP)和2型糖尿病是缺血性脑卒中复发的独立危险因素。Objective To investigate the relationship between recurrence of ischemic cerebral infarction and high on-treatment platelet reactivity on dual antiplatelet treatment patients.Methods According to the 6 months follow-up,87 patients were divided into recurrent group and control group based on the recurrence of ischemic events.The parameters of thromboelastography and clopidogrel gene polymorphisms were compared.Results In the recurrent group,the incidence of diabetes(69.2%vs 37.8%,χ^2=4.46,P=0.04)was higher.Compared with patients without ischemic events,MA ADP was significantly higher and the ADP%was significantly lower in patients with ischemic events.There was no significant difference in MA AA and AA%between two groups.From the ROC curve analysis,the area under the MA ADP curve was 0.749,P=0.004,the area under the ADP%curve was 0.284,P=0.013,indicating that both MA ADP and ADP%made sense to the recurrent ischemic stroke diagnosis.47.15 was the cutoff point,and the sensitivity(84.6%)and specificity(68.9%)were both good.Logistic analysis identified MA ADP and diabetes were independent risk factors for the recurrence of ischemic stroke with OR of 1.077 and 3.791.Conclusion MA ADP was useful for the diagnosis of recurrent ischemic stroke,and 47.15 was the cutoff point of the MA ADP.MA ADP and diabetes were independent risk factors for the recurrence of ischemic stroke.

关 键 词：缺血性脑卒中 复发 血栓弹力图 CYP2C19基因多态性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]