急性脑梗死或短暂性脑缺血发作患者抗血小板治疗后血小板高反应性影响因素分析  

Risk factor analysis of high on-treatment platelet reactivity in patients with acute ischemic stroke or transient ischemic attack undergoing antiplatelet therapy

作　　者：倪晓珺[1] 逄晓云[1] NI Xiaojun;PANG Xiaoyun(Department of Pharmacy,Renji Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院药剂科,上海200127

出　　处：《药学服务与研究》2020年第3期174-177,187,共5页Pharmaceutical Care and Research

摘　　要：目的:分析急性脑梗死或短暂性脑缺血发作(transient ischemic attack,TIA)患者经阿司匹林和氯吡格雷治疗后发生血小板高反应性(high on-treatment platelet reactivity,HTPR)的影响因素。方法:纳入2015年6月至2016年4月在上海交通大学医学院附属仁济医院就诊的267例急性脑梗死或TIA患者,入院后予阿司匹林(100~300 mg/d)和氯吡格雷(75 mg/d)双联抗血小板治疗,用药5 d后利用血栓弹力图(thromboelastography,TEG)检测阿司匹林和氯吡格雷抑制率,将患者分为二磷酸腺苷治疗后血小板高反应性(ADP-HTPR)组、二磷酸腺苷治疗后血小板正常反应性(ADP-NTPR)组和花生四烯酸治疗后血小板高反应性(AA-HTPR)组、花生四烯酸治疗后血小板正常反应性(AA-NTPR)组。比较两组患者的一般临床资料、生化指标、TEG参数,采用多因素logistic回归法分析HTPR的影响因素。结果:267例患者中,16.9%为HTPR,14.2%为ADP-HTPR,5.2%为AA-HTPR。ADP-HTPR组与ADP-NTPR组之间的血红蛋白、血小板计数、慢性肾脏病、血肌酐、红细胞沉降率、MAthrombin、AA-HTPR等因素差异有统计学意义(P<0.05)。Logistic回归分析显示,ADP-HTPR的独立危险因素为AA-HTPR[OR=8.50,95%CI(2.48~29.14)]。结论:急性脑梗死或TIA患者中HTPR的发生率为16.9%,AA-HTPR是ADP-HTPR的独立危险因素。Objective:To analyze risk factors of high on-treatment platelet reactivity(HTPR)in those patients with acute ischemic stroke(AIS)or transient ischemic attack(TIA)undergoing anti-platelet therapy.Methods:Two hundred and sixty-seven patients with AIS or TIA hospitalized in Renji Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University from June 2015 to April 2016 were enrolled for study.Following admission,they received dual anti-platelet therapy of aspirin(100-300 mg/d)and clopidogrel(75 mg/d).After 5 days of medication,the inhibition rates of the 2 drugs were detected by thromboelastography(TEG).Then,the patients were divided into 4 groups,i.e.the adenosine diphosphate HTPR(ADP-HTPR)group,the ADP normal on-treatment platelet reactivity(ADP-NTPR)group,the arachidonic acid HTPR(AA-HTPR)group and the AA-NTPR group.General clinical data,biochemical indexes and TEG parameters were compared between the 2 groups,and risk factors of HTPR were analyzed by logistic regression analysis.Results:Of the 267 patients,16.9%of them wereHTPR,14.2%were ADP-HTPR and 5.2%were AA-HTPR.Significant differences could be found in the indexes of hemoglobin,platelet count,chronic kidney disease,serum creatinine,erythrocyte sedimentation rate,MAthrombin and AA-HTPR,when comparisons were made between the ADP-HTPR and the ADP-NTPR groups(P<0.05).Logistic regression analysis revealed that AA-HTPR was an independent risk factor of ADP-HTPR[OR=8.50,95%CI(2.48-29.14)].Conclusion:The prevalence of HTPR in the patients with AIS or TIA was 16.9%,and AA-HTPR might be an independent risk factor of ADP-HTPR.

关 键 词：脑梗死 急性 脑缺血发作 短暂性 治疗后血小板高反应性 血栓弹力图 

分 类 号：R973.2[医药卫生—药品] R969.3[医药卫生—药学]