缺血性卒中患者平均血小板体积水平与氯吡格雷抵抗的相关性分析

目的观察缺血性卒中患者的氯吡格雷抵抗(clopidogrel resistance,CR)与血小板平均体积(mean platelet volume,MPV)的关系。方法连续入组2013年3月~2014年1月期间在广州医科大学附属第三医院神经内科住院的缺血性卒中患者150例,所有患者均服用氯吡格雷75 mg/d,于用药前、用药物后10~14 d后应用比浊法测定血小板聚集率的变化,依据结果分为CR组和氯吡格雷敏感(clopidogel sensitivity,CS)组,对两组的一般资料、危险因素及MPV水平进行比较,同时采用多因素Logistic回归分析来确定MPV水平与CR的相关性。结果纳入的150例患者中,有44例(29.33%)发生CR,CS组106例。单因素分析中,CR组糖尿病、既往短暂性脑缺血发作(transient ischemic attack,TIA)病史及总胆固醇水平等均高于CS组(P值分别为0.001、0.001和0.004);CR组MPV水平高于CS组(9.55±0.40)fl vs(9.28±0.35)fl,P0.001]。而在多因素Logistic回归分析中显示,MPV水平比值比(odds ratio,OR)10.555,95%可信区间(confidence interval,CI)2.524~44.134,P=0.001]、总胆固醇(OR 1.561,95%CI 1.051~2.318,P=0.027)、既往TIA(OR 6.537,95%CI 2.475~17.262,P=0.000)、糖尿病(OR 7.632,95%CI 2.620~22.228,P=0.000)与CR相关。结论 MPV水平是CR发生的独立危险因素之一,作为CR的预测与筛查工具有一定的价值。

Relationship between the Level of Mean Platelet Volume and Clopidogrel Resistance in Patients with Ischemic Stroke

Objective To observe the relationship between the level of mean platelet volume and clopidogrel resistance in patients with ischemic stroke.
Methods The study continuously chose 150 patients with ischemic stroke during March 2013 to January 2014 in Department of Neurology of the Third Affiliated Hospital of Guangzhou Medical University, all patients taking clopidogrel 75?mg/d, and then used turbidimetry to measure the platelet aggregation rate prior to the drug and 10~14 d after having taken clopidogrel. The patients were divided into clopidogrel resistance (CR) group and clopidogel sensitivity (CS) group according to the change of platelet aggregation rate, compared to the general information, risk factors, and the level of mean platelet volume (MPV). Multivariate Logistic regression analysis was used to identify the relationship with the level of MPV and CR.
Results Total 150 patients with ischemic stroke were included, CR occurred in 44 of them (29.33%), CS group were 106 cases. In single factor analysis, the MPV level of CR group (9.55± 0.40] fl vs 9.28±0.35]fl, P=0.000) were significantly higher than the CS group. The Logistic regression analysis showed that MPV levels (odds ratio OR]10.555, 95% confidence interval CI]2.524~44.134, P=0.001), total cholesterol (OR?1.561, 95%CI?1.051~2.318, P=0.027), the previous transient ischemic attack (TIA) (OR?6.537, 95%CI?2.475~17.262, P=0.000) and diabetes(OR?7.632, 95%CI?2.620~22.228, P=0.000) were correlated with CR.
Conclusion The level of MPV is independent risk factors of CR, and it might be used to predict and screen CR in the early time.