奉贤东部地区缺血性脑卒中患者抗血小板药物抵抗现状及其影响因素分析  

Analysis of the current status of antiplatelet drug resistance and its influencing factors in ischemic stroke patients in eastern Fengxian

作　　者：冉贵萍 袁勇[1] 郭鹏[1] 姚琳[1] 陈英[1] 芦弘 汤恒勇 RAN Gui-ping;YUAN Yong;GUO Peng(Shanghai Jiaotong University Affiliated Ninth People's Hospital Fengcheng Hospital,Shanghai 201411,China)

机构地区：[1]上海交通大学附属第九人民医院奉城分院,201411

出　　处：《中国现代药物应用》2024年第9期5-8,共4页Chinese Journal of Modern Drug Application

基　　金：上海市奉贤区科委项目(项目编号:奉科20201620)。

摘　　要：目的分析奉贤东部地区缺血性脑卒中患者抗血小板药物抵抗发生情况及其影响因素,为临床个体化治疗提供参考依据。方法回顾性分析奉城医院神经内科住院服用阿司匹林、氯吡格雷或二者合用的缺血性脑卒中患者282例,检测入院服药后血小板最大聚集率(MAR)。统计患者的临床资料;分析患者抗血小板药物抵抗发生情况;分析血小板药物抵抗的影响因素。结果282例患者单用阿司匹林的61例,单用氯吡格雷的23例,阿司匹林+氯吡格雷的198例;阿司匹林抵抗(AR)发生率为37.5%(97/259),氯吡格雷抵抗(CR)发生率为46.6%(103/221)。AR患者合并糖尿病比例35.1%高于阿司匹林非抵抗(NAR)患者的22.8%(P<0.05);AR患者与NAR患者年龄、性别、合并高血压、合并冠心病、吸烟史、血小板计数、血小板平均体积、血小板体积分布宽度、大血小板比率(P-LCR)、低密度脂蛋白胆固醇、总胆固醇、糖化血红蛋白、同型半胱氨酸、纤维蛋白原比较无统计学差异(P>0.05)。CR患者女性比例49.5%高于氯吡格雷非抵抗(NCR)患者的35.6%(P<0.05);CR患者与NCR患者年龄、合并高血压、合并糖尿病、合并冠心病、吸烟史、血小板计数、血小板平均体积、血小板体积分布宽度、大血小板比率、低密度脂蛋白胆固醇、总胆固醇、糖化血红蛋白、同型半胱氨酸、纤维蛋白原比较无统计学差异(P>0.05)。Logistic回归分析结果显示,合并糖尿病是AR的独立危险因素(P<0.05)。结论奉贤东部地区缺血性脑卒中患者以高于65岁的老年患者为主,抗血小板药物实验室抵抗率较高且CR率高于AR率,女性较男性更易发生CR;合并糖尿病是AR的独立危险因素,临床工作中应对老年缺血性脑卒中患者积极控制血压血糖,关注是否存在AR、CR,且给予个体化治疗。Objective To analyze the occurrence and influencing factors of antiplatelet drug resistance in ischemic stroke patients in eastern Fengxian,so as to provide reference for individual clinical treatment.Methods A total of 282 patients with ischemic stroke who were hospitalized in the Department of Neurology of Fengcheng Hospital and treated with aspirin,clopidogrel or a combination of the two were selected.The maximum aggregation rate(MAR)after admission was detected.Clinical data of patients were collected;the occurrence of antiplatelet drug resistance was analyzed.The influencing factors of platelet drug resistance were analyzed.Results Among 282 patients,61 cases were treated with aspirin alone,23 cases were treated with clopidogrel alone,and 198 cases were treated with aspirin plus clopidogrel.The incidence of aspirin resistance(AR)was 37.5%(97/259),and the incidence of clopidogrel resistance(CR)was 46.6%(103/221).The proportion of AR patients with combined diabetes was 35.1%,which was higher than 22.8%of non-aspirin resistant(NAR)patients(P<0.05).There were no significant differences between AR patients and NAR patients in terms of age,gender,hypertension,coronary heart disease,smoking history,platelet count,mean platelet volume,platelet volume distribution width,plateletlarge cell ratio(P-LCR),low density lipoprotein cholesterol,total cholesterol,glycated hemoglobin,homocysteine,and fibrinogen(P>0.05).The female proportion of CR patients was 49.5%,which was higher than 35.6%of nonclopidogrel resistant(NCR)patients(P<0.05).There was no significant difference between CR patients and NCR patients in terms of age,hypertension,diabetes,coronary heart disease,smoking history,platelet count,mean platelet volume,platelet volume distribution width,platelet-large cell ratio,low density lipoprotein cholesterol,total cholesterol,glycated hemoglobin,homocysteine,and fibrinogen(P>0.05).Logistic regression analysis showed that diabetes was an independent risk factor for AR(P<0.05).Conclusion The ischemic stroke patients in

关 键 词：缺血性脑卒中 阿司匹林抵抗 氯吡格雷抵抗 血小板聚集率 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R969.3[医药卫生—临床医学]