缺血性脑血管病患者颅内动脉支架植入术后氯吡格雷抵抗的临床特点及风险因素分析  

Analysis of clinical characteristics and risk factors of clopidogrel resistance after intracranial arterial stent implantation in patients with ischemic cerebrovascular disease

作　　者：张丽敏[1] 王冬至 孙越红[1] 李虓[1] 王丹[1] 王平[1] 赵晖[1] 张国军[1] Zhang Limin;Wang Dongzhi;Sun Yuehong;Li Xiao;Wang Dan;Wang Ping;Zhao Hui;Zhang Guojun(Laboratory Diagnosis Center,Beijing Tiantan Hospital,Capital Medical University&Beijing Engineering Research Center of Immunological Reagents Clinical Research,Beijing100070,China)

机构地区：[1]首都医科大学附属北京天坛医院,北京市免疫试剂临床工程技术研究中心实验诊断中心,100070

出　　处：《中国综合临床》2021年第1期7-11,共5页Clinical Medicine of China

基　　金：北京天坛医院青年科学基金(2016-YQN-09);首都医科大学科研培育基金(PYZ2017067)。

摘　　要：目的分析缺血性脑血管病患者颅内动脉支架植入术后氯吡格雷抵抗的临床特点及风险因素。方法采用回顾性病例对照研究方法。选取2017年1月至2018年12月于北京天坛医院住院治疗的缺血性脑血管病患者360例。患者均行颅内动脉支架植入术,术后均服用双联抗血小板药物治疗。根据血栓弹力图所测得的血小板聚集抑制率,将患者划分为氯吡格雷抵抗组和氯吡格雷非抵抗组,采用两组独立样本t检验和Mann-Whitney U检验比较两组患者的临床资料及实验室指标,并采用Logistic回归分析氯吡格雷抵抗可能的风险因素。结果氯吡格雷非抵抗组患者白细胞计数(6.58±1.45)×10^(9)/L、中性粒细胞计数(4.01±1.05)×10^(9)/L、淋巴细胞计数1.83(1.49,2.23)×10^(9)/L、胆固醇(3.63±0.85)mmol/L、低密度脂蛋白胆固醇1.93(1.53,2.31)mmol/L及血清同型半胱氨酸14.3(11.80,17.00)μmol/L。氯吡格雷抵抗组患者白细胞计数(7.19±1.53)×10^(9)/L、中性粒细胞计数(4.40±1.05)×10^(9)/L、淋巴细胞计数2.03(1.63,2.58)×10^(9)/L、胆固醇(4.02±0.99)mmol/L、低密度脂蛋白胆固醇2.04(1.68,2.78)mmol/L及血清同型半胱氨酸15.90(12.25,22.20)μmol/L,两组比较,氯吡格雷抵抗组上述指标水平更高,差异有统计学意义(t=3.277、t=2.867、Z=2.457、t=3.409、Z=2.705、Z=2.220,P值分别为0.001,0.004、0.014、0.001、0.007、0.026)。Logistic回归分析显示高水平血清同型半胱氨酸(OR=1.031,95%CI 1.006~1.057,P=0.015)构成氯吡格雷抵抗的独立风险因素。结论氯吡格雷抵抗患者存在高白细胞计数、血脂及同型半胱氨酸等临床特点,血清高水平同型半胱氨酸是氯吡格雷抵抗的独立风险因素。Objective To analyze the clinical characteristics and risk factors of clopidogrel resistance after intracranial arterial stent implantation in patients with ischemic cerebrovascular disease.Methods Retrospective case-control study was used.A total of 360 patients with ischemic cerebrovascular disease hospitalized in Beijing Tiantan Hospital from January 2017 to December 2018 were selected.All patients received intracranial arterial stenting and received double anti-platelet drugs after operation.Patients were divided into clopidogrel resistance group and non-resistance group according to the inhibition rate of platelet aggregation measured by thromboelastography.Clinical data and laboratory indicators of patients in the two groups were compared using two independent sample T tests and Mann-Whitney U tests,and possible risk factors of clopidogrel resistance were analyzed by Logistic regression.Results White blood cell(WBC)count,neutrophils count,lymphocyte count,cholesterol,LDL cholesterol,and serum homocysteine levels in the clopidogrel non-resistant group were(6.58±1.45)×10^(9)/L,(4.01±1.05)×10^(9)/L,1.83(1.49,2.23)×10^(9)/L,(3.63±0.85)mmol/L,1.93(1.53,2.31)mmol/L,and 14.3(11.80,17.00)μmol/L,respectively.Compared with the clopidogrel non-resistant group,the WBC count,neutrophils count,lymphocyte count,cholesterol,LDL cholesterol and serum homocysteine levels in the clopidogrel resistant group were all higher(7.19±1.53)×10^(9)/L,(4.40±1.05)×10^(9)/L,2.03(1.63,2.58)×10^(9)/L,(4.02±0.99)mmol/L,2.04(1.68,2.78)mmol/L and 15.90(12.25,22.20)μmol/L,respectively.The difference was statistically significant(t=3.277,t=2.867,Z=2.457,t=3.409,Z=2.705 and Z=2.220,respectively;P value were 0.001,0.004,0.014,0.001,0.007 and 0.026,respectively).Logistic regression analysis showed that high serum homocysteine(OR=1.031,95%CI 1.006-1.057,P=0.015)was an independent risk factor for clopidogrel resistance.Conclusion Patients with clopidogrel resistance have high leucocyte,blood lipid,homocysteine and other clinical charac

关 键 词：缺血性脑血管病 氯吡格雷抵抗 颅内动脉支架植入术 血栓弹力图 

分 类 号：R743[医药卫生—神经病学与精神病学]