脑血管狭窄行神经血管介入术后不良事件与抗血小板药物抵抗的相关性研究  

Correlation between adverse events and antiplatelet drug resistance after neurovascular intervention for cerebrovascular stenosis

作　　者：孙孟坊 金孟浩 王丰 汪德秀 Mengfang Sun;Menghao Jin;Feng Wang;Dexiu Wang(Department of Neurosurgery,Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]温州市中西结合医院神经外科,温州325000

出　　处：《中国基层医药》2023年第10期1446-1450,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市基础性科研计划(Y20200439)。

摘　　要：目的探讨脑血管狭窄行神经血管介入术后不良事件与抗血小板药物抵抗的相关性。方法选取温州市中西结合医院2020年1-12月行神经血管介入治疗的脑血管狭窄患者148例为研究对象,记录患者抗血小板药物治疗前及治疗后24 h血小板功能,分析抗血小板药物抵抗情况;于神经血管介入术后3个月、6个月、1年通过随访的方式记录患者不良事件,采用病例对照研究方法,根据患者是否发生不良事件分为发生组和未发生组,采用Spearman相关系数分析神经血管介入术后不良事件与抗血小板药物抵抗的相关性。结果148例患者随访1年,29例失访,最终纳入119例患者,其中41例发生不良事件,未发生不良事件78例。发生组用药前血小板膜糖蛋白P-选择素、血小板活化复合物表达水平分别为(20.22±6.33)%、(68.80±11.52)%,用药后分别为(15.77±4.12)%、(43.19±5.90)%,均高于未发生组[用药前:(16.85±3.24)%、(62.34±10.77)%,用药后:(8.31±2.97)%、(35.85±5.14)%](用药前:t=3.20、2.97,均P<0.05;用药后:t=10.28、6.74,均P<0.05)。发生组阿司匹林抵抗、氯吡格雷抵抗发生率分别为51.2%(21/41)、43.9%(20/41),均高于未发生组的26.9%(8/78)、19.2%(9/78)(χ^(2)=24.47、20.23,均P<0.001)。Spearman相关性分析显示,阿司匹林抵抗、氯吡格雷抵抗均与神经血管介入术后不良事件发生呈中等强度正相关(r=0.45、0.41,均P<0.05)。结论脑血管狭窄神经血管介入术后不良事件与抗血小板药物阿司匹林、氯吡格雷抵抗均呈中等强度正相关。Objective To investigate the correlation between adverse events and antiplatelet drug resistance after neurovascular intervention for cerebrovascular stenosis.Methods A total of 148 patients with cerebrovascular stenosis who underwent neurovascular intervention at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to December 2020 were included in this study.The platelet function of patients before and 24 hours after antiplatelet drug treatment was recorded.Platelet drug resistance was analyzed.At 3,6 months,and 1 year after neurovascular intervention,adverse events were recorded through follow-up.The patients were divided into the occurrence group and the non-occurrence group according to whether adverse events occurred or not using the case-control study method.The Spearman correlation coefficient was used to analyze the correlation between adverse events and antiplatelet drug resistance after neurovascular intervention for cerebrovascular stenosis.Results After 1 year of follow-up,among the 148 patients,29 patients lost their follow-up,and 119 were included in the final analysis.Of the 119 patients,41 patients had adverse events and 78 patients had no adverse events.In the occurrence group,the expression levels of platelet membrane glycoprotein P-selectin and platelet activating complex were(20.22±6.33)%and(68.80±11.52)%,respectively,before drug treatment,and they were(15.77±4.12)%and(43.19±5.90%)%,respectively,after drug treatment,all of which were significantly higher than those in the non-occurrence group[before drug treatment:(16.85±3.24)%,(62.34±10.77)%,after drug treatment:(8.31±2.97)%,(35.85±5.14)%](before drug treatment:t=3.20,2.97,both P<0.05;after drug treatment:t=10.28,6.74,both P<0.05).The incidences of aspirin resistance and clopidogrel resistance in the occurrence group were 51.2%(21/41)and 43.9%(20/41),respectively,which were significantly higher than 26.9%(8/78)and 19.2%(9/78)in the non-occurrence group(χ^(2)=24.47,20.23,both P<0.001).Spearman cor

关 键 词：缩窄 病理性 脑血管障碍 神经外科手术 神经血管介入 阿司匹林 氯吡格雷 不良事件 血小板膜糖蛋白类 血小板活化复合物 

分 类 号：R651.1[医药卫生—外科学]