缺血性脑卒中和短暂性脑缺血发作患者氯吡格雷抵抗及其影响因素分析

目的观察北方汉族人群缺血性脑卒中及短暂性脑缺血发作(TIA)患者氯吡格雷抵抗的发生率,并分析可能相关的影响因素。方法共入选104例接受氯吡格雷75 mg·d-1治疗的动脉粥样硬化性脑梗死及TIA患者,于治疗前及治疗后第7天,应用比浊法检测腺苷二磷酸诱导的血小板聚集率。以血小板聚集率下降≤10%为划界,分为氯吡格雷抵抗(CR)组37例(35.58%)和非氯吡格雷抵抗(NCR)组67例(64.42%)。采集两组患者的病史及临床资料,进行统计学分析。结果 CR组合并2型糖尿病和高血压病的患病率高于NCR组(分别P=0.024,P=0.008);CR组血清胆固醇水平和体重指数(BMI)高于NCR组(分别P=0.040,P=0.013)。多因素Logistic回归分析提示BMI≥28 kg/m2与氯吡格雷抵抗可能具有相关性(OR=3.600,95%CI:1.110~11.678,P=0.033)。结论 BMI≥28 kg/m2可能为缺血性脑卒中及TIA患者发生氯吡格雷抵抗的危险因素

Clopidogrel Resistance and Correlative Factor Analysis in Patients with Ischemic Stroke and Transient Ischemic Attack

Aim To investigate the incidence of clopidogrel resistance (CR) patients with ischemic stroke in northern Han population, and analyze the possible correlative clinical factors.Methods A total of 104 patients with atherosclerotic cerebral infarction and transient ischemic attack (TIA) treated with clopidogrel (75 mg·d-1) were selected. The platelet aggregation induced by adenosine diphosphate was tested by light transmission aggregometry before medication and in the seventh day after medication, the patients with the platelet aggregation rate decreased no more than 10% were divided into CR group, otherwise into NCR group. The medical history and clinical data were collected and analyzed statistically. Results Among the 104 patients enrolled, 37 patients (35.58%) occurred CR, the ratio of combination of type 2 diabetes mellitus and hypertension in the CR group was higher than that in the NCR group (P=0.024,P=0.008). The level of cholesterol in the serum and BMI in the CR group was higher than that in the NCR group (P=0.040,P=0.013). Logistic regression analysis indicated that BMI≥28 kg/m2 (OR=3.600, 95% CI:1.110-11.678,P=0.033) may be correlated with CR.Conclusion Clopidogrel resistance may be associated with BMI≥28 kg/m2 in the patients with ischemic stroke.