急性缺血性脑卒中患者抗血小板药物反应性与血小板参数及凝血功能的关系  

Correlation between drug on platelet reactivity with platelet parameters and coagulation function in patients with acute ischemic stroke

作　　者：张建东 武湘云[1] 任慧玲[2] 吴华 徐玉珠 何兴娟[1] ZHANG Jiandong;WU Xiangyun;REN Huiling(Department of Laboratory Medicine,the Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China;不详)

机构地区：[1]河北医科大学第三医院检验科,石家庄市050000 [2]河北医科大学第三医院神经内科,石家庄市050000

出　　处：《河北医药》2023年第6期876-878,882,共4页Hebei Medical Journal

基　　金：河北省2021年政府资助临床医学人才培养项目。

摘　　要：目的 探讨急性缺血性脑卒中患者抗血小板药物反应性与血小板参数及凝血功能的关系。方法 收集在河北医科大学第三医院神经内科住院的服用阿司匹林和氯吡格雷的急性缺血性卒中患者214例,用药后测定血小板功能。根据抗血小板抵抗将其分为阿司匹林抵抗组,氯吡格雷抵抗组,阿司匹林敏感组与氯吡格雷敏感组。比较各组血小板参数与凝血指标并分析抗血小板抵抗与血小板参数[血小板数量(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、血小板压积(P-CT)]、凝血指标[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、 D-二聚体(D-D)、凝血酶凝结时间(TT)]的相关性。结果 应用阿司匹林和氯吡格雷治疗后患者组的PT、APTT、TT均较治疗前延长,差异有统计学意义(P<0.05),FIB、D-D、PDW较治疗前降低,差异均有统计学意义(P<0.05)。阿司匹林敏感组与抵抗组FIB差异有统计学意义(P<0.05),其余各指标差异无统计学意义(P>0.05)。氯吡格雷敏感组和抵抗组在TT和PDW上差异有统计学意义(P<0.05),其余各指标差异无统计学意义(P>0.05)。相关性分析显示TT和PDW与氯吡格雷的反应性相关(P<0.05)。结论 缺血性脑卒中患者应用阿司匹林和氯吡格雷后,凝血指标与血小板参数均有差异变化,TT和PDW与氯吡格雷的反应性相关,可作为氯吡格雷抵抗的参考指标用于联合监测。Objective To explore the correlation between drug on platelet reactivity with platelet parameters and coagulation function in patients with acute ischemic stroke(AIS).Methods We conducted drug administration of aspirin and clopidogrel in 214 AIS patients who visited the Department of Neurology,the Third Hospital of Hebei Medical University,and detected their platelet function.The patients were assigned to aspirin resistance(AR)group,clopidogrel resistance(CR)group,aspirin-sensitive(AS)group,clopidogrel-sensitive(CS)group according to whether presence or absence of antiplatelet resistance.The platelet parameters and coagulation indexes were recorded,the correlation between drug on platelet reactivity with platelet parameters(platelet[PLT]count,mean platelet volume[MPV],platelet distribution width[PDW],plateletcrit[PCT]),and coagulation function indexes(prothrombin time[PT],activated partial thromboplastin time[APTT],fibrinogen[FIB],D-dimer[D-D],thrombin time[TT]).Results After treatment,PT,APTT,and TT in all groups were significantly longer(P<0.05),and FIB,D-D,and PDW were significantly decreased(P<0.05).FIB in AS group and AR group had statistical difference(P<0.05),and there was no difference in other indexes.There was significant difference in TT and PDW between CS group and CR group(P<0.05),and with no difference in other indicators.Correlation analysis showed that TT and PDW were related to clopidogrel on platelet reactivity(P<0.05).Conclusion The application of aspirin and clopidogrel can take difference change in coagulation indicators and platelet parameters of IS patients.Due to TT and PDW are related to clopidogrel on platelet reactivity,it can be great reference indexes for joint monitoring of clopidogrel on platelet reactivity.

关 键 词：抗血小板药物治疗 血小板参数 凝血功能 急性缺血性脑卒中 

分 类 号：R743[医药卫生—神经病学与精神病学]