抗血小板治疗后血小板高反应性与急性非心源性脑梗死早期神经功能恶化的关系

摘要

Objective To study the relationship between high on-treatment platelet reactivity (HTPR) and early neurological deterioration (END) in acute non-cardiogenic cerebral infarction patients.Methods Two hundred and fifteen acute non-cardiogenic cerebral infarction patients were divided into END group (n=55) and EDD-free group (n=160).The patients were given oral aspirin (300 mg daily) on the day after admission,and fasting blood samples were taken at 6-24 h after the first dose of aspirin.Their platelet aggregative function (PAGT) was assayed with ADP to detect the platelet responsiveness to aspirin.The incidence of HTPR was compared between the two groups.The independent risk factors for END were analyzed by multivariate logistic regression analysis.The value of PAGT in predicting END was assessed according to its ROC curve.Results The incidence of HTRP was higher in END group than in END-free group (63.34％ vs 43.75％,P＜0.05).Multivariate logistic regression analysis showed that HTRP was an independent risk factor for acute non-cardiogenic cerebral infarction.The area under the ROC curve was 0.864 for PAGT in predicting acute non-cardiogenic cerebral infarction (95 ％ CI:0.806-0.922,P=0.000).Conclusion HTPR is closely related with END in acute non-cardiogenic cerebral infarction patients.%目的 探讨抗血小板治疗后血小板高反应性(HTPR)与急性非心源性脑梗死早期神经功能恶化(END)的关系.方法 入选急性非心源性脑梗死患者215例,根据入院72 h内神经功能有无恶化分为END组55例和非END组160例.全部患者入院当日开始口服阿司匹林300 mg后6～24 h空腹取血,检测血脂及糖化血红蛋白(HbA1c)等,并以二磷酸腺苷为诱导剂测定血小板聚集功能(PAGT),比较2组HTPR发生率,采用多因素logistic回归分析END的独立危险因素,采用ROC曲线评估PAGT对END的预测价值.结果 END组LDL[(3.23±0.75)mmol/L vs (3.02±0.63)mmol/L]、HbA1c[(6.75±0.65)％ vs (6.70±0.54)％]明显高于非END组(P＜0.01).END组HTPR发生率明显高于非END组,差异有统计学意义(63.34％ vs 43.75％,P=0.011),多因素logistic回归分析显示,LDL、HbA1c和HTPR是急性非心源性脑梗死患者END的独立危险因素(OR=9.023,95 ％CI:3.085～26.387,P=0.000,OR=11.344,95％CI:3.882～33.152,P=0.000,OR=34.364,95％CI:4.422～267.029,P=0.001,),PAGT判断急性非心源性脑梗死END的ROC曲线下面积为0.864(95％CI:0.806～0.922,P=0.000).结论 HTPR与急性非心源性脑梗死END密切相关.