缺血性脑卒中患者氯吡格雷抵抗与血小板平均体积的关系研究

摘要

目的：探讨缺血性脑卒中患者氯吡格雷抵抗与血小板平均体积（MPV）的关系。方法选取2012年3月—2014年3月在南昌市第三医院接受治疗的缺血性脑卒中患者146例，根据服药前后血小板聚集率变化分为氯吡格雷敏感组113例和氯吡格雷抵抗组33例。自行设计《脑卒中患者信息收集表》，内容包括年龄、性别、吸烟史、饮酒史、糖尿病病史、高血压病史、短暂性脑缺血发作（TIA）发生情况、空腹血糖（FBG）、血脂、血小板计数（PLT）、MPV、血小板压积（PCT）、血小板分布宽度（PDW）等。采用多因素 Logistic 回归分析和受试者工作特征曲线（ROC曲线）确定 MPV 与氯吡格雷抵抗的相关性。结果氯吡格雷抵抗组患者饮酒史、糖尿病病史阳性率及 TIA 发生率、总胆固醇（TC）高于氯吡格雷敏感组，MPV 大于氯吡格雷敏感组，PCT 小于氯吡格雷敏感组（ P ＜0.05）。多因素Logistic 回归分析结果显示，有饮酒史〔 OR ＝2.423，95% CI（1.133，3.968）〕、有 TIA〔 OR ＝2.141，95% CI （2.245，3.352）〕、高水平 TC〔OR ＝2.036，95% CI（1.857，3.757）〕及 MPV 增大〔OR ＝2.411，95% CI（2.028，2.998）〕是氯吡格雷抵抗的独立危险因素（P ＜0.05）。MPV 预测氯吡格雷抵抗的 ROC 曲线显示，曲线下面积（AUC）为0.853〔95% CI（0.756，0.950），P ＜0.001〕；当 MPV ＝9.394 fl 时，MPV 预测氯吡格雷抵抗的灵敏度和特异度最佳，分别为84.96%和78.79%。结论 MPV 对缺血性脑卒中患者氯吡格雷抵抗的预测价值较高，当 MPV ＞9.394 fl 时患者发生氯吡格雷抵抗的危险性升高。%Objective To explore the relationship between clopidogrel resistance and mean platelet volume(MPV) in ischemic stroke patients. Methods A total of 146 patients with ischemic stroke were selected in the Third Hospital of Nanchang from March 2012 to March 2014,and they were divided into A group(without clopidogrel resistance,n = 113)and B group(with clopidogrel resistance,n = 33) according to platelet aggregation rate before and after treatment. Self - made Information Collection Table of Stroke Patients was used to collect the patients'information,including age,gender,smoking history,drinking history,diabetes history,incidence of transient ischemic attack( TIA),fasting blood glucose( FBG), blood lipid, blood platelet count ( PLT ), MPV, thrombocytocrit ( PCT ), platelet distribution width ( PDW ) and so on. Multivariate Logistic regression analysis and ROC curve were used to analyze the relationship between clopidogrel resistance and MPV. Results The positive rates of drinking history and diabetes history,incidence of TIA,total cholesterol( TC), MPV of B group were statistically significantly higher than those of A group,PCT of B group was statistically significantly lower than that of A group(P < 0. 05). Multivariate Logistic regression analysis showed that,drinking history〔OR = 2. 423,95% CI (1. 133,3. 968)〕,TIA〔 OR = 2. 141,95% CI(2. 245,3. 352)〕,high - level TC〔 OR = 2. 036,95% CI(1. 857, 3. 757)〕,increased MPV〔OR = 2. 411,95% CI(2. 028,2. 998)〕 were risk factors of clopidogrel resistance(P < 0. 05). ROC curve showed that,area under the curve( AUC) of MPV in predicting clopidogrel resistance was 0. 853 〔 95% CI (0. 756,0. 950),P < 0. 001〕,and 9. 394 fl was the best critical value,the sensitivity was 84. 96% ,the specificity was 78. 79% . Conclusion MPV has certain predicting value on clopidogrel resistance in ischemic stroke patients,the onset risk of clopidogrel resistance significantly increased when MPV was over 9. 394 fl.