氯吡格雷抵抗在脑梗死患者中的动态观察

【摘要】
目的 探讨氯吡格雷抵抗（clopidogrel resistance，CR）在脑梗死患者中的动态变化；观察脑梗死组与高危组（脑梗死高危因素）CR发生率及血小板聚集率变化情况。
方法 收集健康对照组68例、高危组59例、脑梗死组121例，采用光比浊法分别测定入组（氯吡格雷75 mg/d）2周后的血小板聚集率；服药2周后，出现CR者换用或联合其他抗血小板药物治疗，并检测其2周后的血小板聚集率的变化；非CR的脑梗死患者维持常规治疗，观察3个月、6个月后血小板聚集率的变化。
结果 服药前，脑梗死组［（65.75±13.11）%］分别与健康对照组［（50.49±12.42）%］、高危组［（56.71±11.33）%］比较血小板聚集率，差异有显著性（t =4.534，P =0.000；t =7.829，P =0.000）；服药2周后，高危组CR发生率为13.6%（8例），脑梗死组的发生率为29.75%（36例），且两组患者发生CR的患者中患糖尿病比例均较高（分别为50%和41.67%）；换用或联合其他抗血小板药物治疗后，70%CR者的血小板聚集率下降>10%；服药3个月后脑梗死组未见新CR；服药6个月后脑梗死组新发CR者15例（17.65%）。
结论 脑梗死组CR发生率较高，CR在脑梗死患者中可能存在时相动态变化。

Dynamic Observation of Clopidogrel Resistance in Patients with Cerebral Infarction Sill

Objective To investigate the dynamic changes in patients with cerebral infarction（CI） of clopidogrel resistance（CR）, and to observe the change of rate of platelet aggregation（ARPA） and the incidence rate of CR in patients with ischemic stroke and high risk（high risk factors of stroke）. Methods Sixty-eight cases in normal people and 59 cases in patients with high risk（HR） and 121 cases in patients with CI were enrolled. The rate of platelet aggregation（RPA） was examined on baseline and two weeks after medication（clopidogrel 75 mg/d）. The patients who had CR were used or combined with other antiplatelet drug to investigate the ARPA after two weeks. Patients who had non-CR continued to be given clopidogrel 75 mg/d to investigate ARPA after three months and six months. Results Before overdosed, CI group（65.75±13.111%） respectively compared with normal group（50.49±12.421%） and HR group（56.71±11.331%）, which the RPA had a significant difference（t=4.534, P=0.000 vs t=7.829, P=0.000）; The incidence of CR in patients with HR was 13.6%（8 cases）, the incidence of CR in patients with CI was 29.75%（36 cases）. Three months after overdosed the incidence of new CR in patients with CI was not detected, six months after overdosed the incidence of new CR in patients with CI was 17.65%; When other antiplatelet drug were used, RPA decreased by 〉10% in 70% CR patients. Conclusion The incidence of CR in patients with CI was higher. Dynamic changes of CR may occur in patients with CI.