甘油三酯–葡萄糖指数与缺血性卒中患者氯吡格雷治疗期间血小板高反应性的相关性  

Correlation between triglyceride-glucose index and high on-treatment platelet reactivity during clopidogrel treatment in patients with ischemic stroke

作　　者：陈豪选 杨丽 娄真真 詹沂博 欧阳卉莹 陈桂仙 张昌林 毛慧 李晓君 黄志萍[1] 郑泽泉 许浩游[1] 文龙龙[1] 赵敏[1] 招远祺[1] Chen Haoxuan;Yang Li;Lou Zhenzhen;Zhan Yibo;Ouyang Huiying;Chen Guixian;Zhang Changlin;Mao Hui;Li Xiaojun;Huang Zhiping;Zheng Zequan;Xu Haoyou;Wen Longlong;Zhao Min;Zhao Yuanqi(Guangdong Provincial Hospital of Chinese Medicine,Guang-zhou 510120,China;The Second Clinical Medicine School of Guangzhou University of Chinese Medicine,Guangzhou 510006,China)

机构地区：[1]广东省中医院,广州510120 [2]广州中医药大学第二临床医学院,广州510006

出　　处：《国际脑血管病杂志》2023年第4期253-258,共6页International Journal of Cerebrovascular Diseases

基　　金：省部共建中医湿证国家重点实验室(SZ2020ZZ23);广州市科技计划项目(202002020034);广东省中医药管理局科研项目(20225030);广东省中医药应急研究重点实验室专项项目(2019KT1340)。

摘　　要：目的探讨甘油三酯–葡萄糖(triglyceride-glucose,TyG)指数与缺血性卒中患者氯吡格雷治疗期间血小板高反应性(high on-treatment platelet reactivity,HTPR)的相关性。方法回顾性纳入2017年1月至2021年3月在广东省中医院神经内科住院并接受维持剂量氯吡格雷(75 mg/d)治疗的缺血性卒中患者。TyG指数最高四分位数(Q4)定义为胰岛素抵抗。通过血栓弹力图评估血小板反应性,将二磷酸腺苷诱导的凝块强度MAADP>47 mm定义为氯吡格雷HTPR。应用多变量回归模型分析TyG指数与血小板反应性的独立相关性。结果共纳入83例患者,TyG指数与MAADP呈线性相关。根据TyG指数四分位数将患者分为4组。氯吡格雷HTPR发生率随TyG指数四分位数增加显著增高(P趋势=0.017)。多变量分析显示,胰岛素抵抗与氯吡格雷HTPR存在显著独立相关性(优势比4.597,95%置信区间1.285~16.446;P=0.019)。结论在接受氯吡格雷治疗的缺血性卒中患者中,氯吡格雷HTPR发生率随TyG指数四分位数增高而逐渐增高,TyG指数评估的胰岛素抵抗与氯吡格雷HTPR独立相关。Objective To investigate the correlation between triglyceride-glucose(TyG)index and high on-treatment platelet reactivity(HTPR)during clopidogrel treatment in patients with ischemic stroke.Methods Patients with ischemic stroke who received maintenance dose of clopidogrel(75 mg/d)in the Department of Neurology,Guangdong Provincial Hospital of Chinese Medicine from January 2017 to March 2021 were retrospectively included.The highest quartile(Q4)of the TyG index was defined as insulin resistance.Platelet reactivity was assessed by thromboelastogram and clopidogrel HTPR was defined as the clot strength induced by adenosine diphosphate(MAADP)>47 mm.Multivariate regression model was used to analyze the independent correlation between TyG index and platelet reactivity.Results A total of 83 patients were included.The TyG index showed a linear correlation with MAADP.The patients were divided into 4 groups according to the quartile of TyG index.The incidence of clopidogrel HTPR increased significantly with the increase of the quartile of the TyG index(Ptrend=0.017).Multivariate analysis showed that there was a significant independent correlation between insulin resistance and clopidogrel HTPR(odds ratio 4.597,95%confidence interval 1.285-16.446;P=0.019).Conclusions In patients with ischemic stroke treated with clopidogrel,the incidence of clopidogrel HTPR gradually increases with the increase of the quartile of the TyG index.The insulin resistance assessed by the TyG index is independently associated with clopidogrel HTPR.

关 键 词：缺血性卒中 甘油三酯 血糖 胰岛素抗药性 氯吡格雷 血栓弹力描记术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]