二磷酸腺苷抑制率指导轻型脑卒中或高危短暂性脑缺血发作双联抗血小板方案  

Dual antiplatelet regimen in mild stroke or high-risk transient ischemic attack guided by the rate of adenosine diphosphate inhibition

作　　者：王晓辉[1] 崔小丽[1] 王文秀[1] 李志伟[1] 胡军[1] 陈红男 常莎 WANG Xiaohui;CUI Xiaoli;WANG Wenxiu;LI Zhiwei;HU Jun;CHEN Hongnan;CHANG Sha(Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院,陕西西安710068

出　　处：《中国实用神经疾病杂志》2023年第1期7-12,共6页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省自然科学基础研究计划项目(编号:2021JQ-903)。

摘　　要：目的探讨二磷酸腺苷(ADP)抑制率指导轻型脑卒中或高危短暂性脑缺血发作(TIA)患者调整双联抗血小板方案的可行性和安全性。方法选取2020-01—2022-03在陕西省人民医院接受治疗的轻型脑卒中或高危TIA患者268例,所有患者在发病24 h内采用阿司匹林联合氯吡格雷进行抗血小板治疗,治疗3 d后检测ADP抑制率,根据ADP抑制率分为A组、B组和C组。A组患者不调整治疗方案,B组和C组患者在医师指导下选择原方案治疗或将氯吡格雷改为替格瑞洛。观察出院时间、治疗期间的血小板反应指数(PRI)和血小板-纤维蛋白凝块强度(MAADP)、出血事件和不良反应以及随访3个月的再发脑卒中率。结果A组119例患者中未调整治疗方案,B组79例患者中40例调整了治疗方案,C组70例患者中36例调整了治疗方案。A组患者的住院时间、MAADP、PRI、再发脑卒中率均低于B组和C组(P<0.05),B组和C组的住院时间、MAADP、PRI、再发脑卒中率比较差异无统计学意义(P>0.05)。B组和C组中调整治疗方案患者的住院时间、MAADP、PRI、再发脑卒中率均低于未调整治疗方案者(P<0.05)。B组和C组中调整治疗方案患者的住院时间、MAADP、PRI、再发脑卒中率与A组比较差异无统计学意义(P>0.05)。各组患者均未发生出血事件。各组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论ADP抑制率>70%的轻型脑卒中或高危TIA患者采用阿司匹林联合氯吡格雷方案治疗可取得满意的治疗效果,ADP抑制率较低的患者更换治疗方案可获益。Objective To investigate the feasibility and safety of adjusting dual antiplatelet regimen in pa⁃tients with mild stroke or high-risk transient ischemic attack(TIA)guided by adenosine diphosphate(ADP)inhi⁃bition rate.Methods A total of 268 patients with mild stroke or high-risk TIA who were treated in Shaanxi Pro⁃vincial People’s Hospital from January 2020 to March 2022 were selected.All patients received antiplatelet thera⁃py with aspirin combined with clopidogrel within 24 hours of onset.After 3 days,the ADP inhibition rate was detected,and they were divided into group A,group B and group C according to the inhibition rate of ADP.The pa⁃tients in group A did not adjust the treatment plan,and the patients in group B and group C were suggested to change the treatment plan,and the patients or their families could choose the original treatment plan or change the clopidogrel to ticagrelor.Discharge time,platelet reaction index(PRI)and platelet-fibrin clot strength(MAADP)during treatment,bleeding events and adverse reactions,and the rate of recurrent stroke during 3-month follow-up were observed.Results No one of the 119 patients in group A adjusted the treatment plan,40 of the 79 patients in group B adjusted the treatment plan,and 36 of the 70 patients in group C adjusted the treatment plan.The hos⁃pitalization time,MAADP,PRI,and recurrent stroke rate of patients in group A were lower than those in group B and group C(P<0.05),of which there were no statistical significances between group B and group C(P>0.05).In group B and group C,the hospitalization time,MAADP,PRI,and recurrence rate of stroke in patients with adjusted treatment plan were lower than those without treatment plan(P<0.05).There were no significant differences between group B and group C in the hospitalization time,MAADP,PRI,and recurrent stroke rate of patients who adjusted the treatment plan and group A(P>0.05).No bleeding events occurred in any group of patients.There were no significant differences in the incidence of adverse reactio

关 键 词：短暂性脑缺血发作 轻型脑卒中 抗血小板 二磷酸腺苷抑制率 阿司匹林 氯吡格雷 替格瑞洛 

分 类 号：R743[医药卫生—神经病学与精神病学]