血小板高反应性、坚果消费状况与大动脉粥样硬化性脑梗死复发的相关性研究

目的 探讨血小板高反应性、坚果消费状况与大动脉粥样硬化性脑梗死复发的相关性。 方法 采用前瞻性队列研究，连续收集2016年10月-2018年10月在西安交通大学第二附属医院神经 内科住院治疗的大动脉粥样硬化性脑梗死患者的临床资料，包括患者的一般资料、对阿司匹林/氯 吡格雷治疗反应性和坚果消费情况。所有患者共随访6个月，根据缺血性卒中是否复发将患者分为复 发组和对照组。通过多因素Logistic回归分析探讨血小板高反应性、坚果消费情况与缺血性卒中复发 的关系。 结果 最终共纳入214例患者进行分析，其中缺血性卒中复发组36例（16.8%），对照组178例 （83.2%）。复发组糖尿病患病率、入院时基线LDL-C水平高于对照组，差异有统计学意义。复发组坚 果消费率为11.1%（4/36），低于对照组21.3%（38/178），但差异无统计学意义；复发组人群坚果摄 入量（P90）为6.6 g/d，坚果消费者的坚果摄入量（P50）为9.0 g/d，均较对照组偏低，但差异均无统 计学意义。复发组阿司匹林抵抗及氯吡格雷抵抗的检出率较对照组高（27.8% vs 17.4%；55.6% vs 31.5%），但只有氯吡格雷抵抗在两组间差异有统计学意义（P =0.006）。Logi sti c回归分析显示，氯 吡格雷抵抗（OR 2.813，95%CI 1.282～6.171，P =0.010）、糖尿病（OR 3.485，95%CI 1.571～7.729， P =0.002）、高LDL-C水平（OR 1.710，95%CI 1.078～2.710，P =0.023）是大动脉粥样硬化性脑梗死复发 的独立危险因素。 结论 氯吡格雷抵抗与大动脉粥样硬化性脑梗死复发有关；复发患者中坚果消费低于无复发患者， 但未能证明坚果消费是脑梗死复发的影响因素。

Relationship between High On-treatment Platelet Reactivity,Nut Consumption and Recurrent Atherosclerotic Cerebral Infarction

Objective To investigate the correlation between high on-treatment platelet reactivity, nut
consumption and recurrent ischemic stroke in patients with large artery atherosclerosis cerebral
infarction.
Methods This was a prospective cohort study. The patients with large artery atherosclerotic cerebral
infarction who consecutively admitted to Department of Neurology of the Second Affiliated Hospital
of Xi'an Jiao Tong University from October 2016 to October 2018 were enrolled in this study. The
collected clinical data included baseline information, response to aspirine / clopidogrel and nut
consumption results. All patients were followed up for 6 months. The patients were divided into
recurrence group and control group according to whether the patient experienced recurrent ischemic
stroke or not. Multivariate logistic regression analysis was conducted to analyze the relationship
between high on-treatment platelet reactivity, nut consumption and recurrent ischemic stroke.
Results Finally, a total of 214 patients were included, with 36 cases (16.8%) in recurrence groupand 178 cases (83.2%) in control group. The rate of diabetes, baseline LDL-C level in recurrence
group were higher than that in control group (P <0.05). The nut consumption rate in recurrence
group was lower than that in control group, but there was no statistical difference (11.1% vs 21.3%).
The nut intake (P90) in recurrence group was 6.6 g/d, and the nut intake (P50) of the nut consumers
was 9.0 g/d, both were lower than that in control group, but the differences were not statistically
significant. The detection rates of aspirin resistance and clopidogrel resistance in recurrence
group were higher than those in control group (27.8% vs 17.4%; 55.6% vs 31.5%), but only
clopidogrel resistance was statistically significant (P =0.006). Logistic regression analysis showed
that clopidogrel resistance (OR 2.813, 95%CI 1.282-6.171, P =0.010), diabetes (OR 3.485, 95%CI
1.571-7.729, P =0.002) and high LDL-C level (OR 1.710, 95%CI 1.078-2.710, P =0.023) were
independent risk factors of recurrent ischemic stroke in patients with large artery atherosclerosis
cerebral infarction.
Conclusions Clopidogrel resistance was associated with recurrent ischemic stroke in patients with
large artery atherosclerotic cerebral infarction. Nut consumption in patients with recurrent ischemic
stroke was lower than that in patients without stroke recurrence, while which did not confirm that
nut consumption was an independent influence factor for recurrent ischemic stroke.