缺血性脑卒中患者血小板功能与缺血性血管事件复发的相关性研究

摘要

Objective To investigate the relationship between the platelet functions and the recurrent ischemic vascular events in secondary prevention of ischemic stroke during the follow-up periods.Methods Aspirin was taken from the first day of admission in 350 patients with ischemic stroke within 72 hours.Platelet aggregation ratio measured by PL series platelet function analyzer (PL-11) after 7-10 days and the demographic characteristics were recorded.All patients were followed up for 6 months and the recurrent vascular events were recorded.Logistic regression model was used to estimate the risk factors of vascular events and receiver operating characteristic curve analysis was used to estimate the predictive value of platelet aggregation ratio in recurrent ischemic vascular events.Results Of the 350 patients,52 patients had ischemic vascular events recurrence and 298 patients did not have recurrence.Ischemic vascular events recurrence group was more likely to be with diabetes (48.08％ (25/52) vs 23.15％ (69/298),x2 =14.000,P ＜ 0.01),low-density lipoprotein (LDL) cholesterol ((3.02 ± 0.74) mmol/L vs (2.74 ± 0.72) mmol/L,t =2.410,P =0.016),arachadonic acid-induced maximum platelet aggregation ratio (MAR-AA;27.31％ ± 9.49％ vs 18.85％ ± 6.60％,t =6.173,P ＜ 0.01),and epinephrine-induced maximum platelet aggregation ratio (MAR-EPI;61.26％±13.02％ vs 51.41％ ± 14.81％,t =4.498,P＜0.01).Diabetes,LDL cholesterol,MAR-AA and MAR-EPI were risk factors for recurrent ischemic vascular events.MAR-AA (OR =1.133,95％ CI 1.080-1.188,P ＜0.01) was closely correlated with ischemic vascular events recurrence during the follow-up period and had a greater predictive value,and the area under the receiver operating characteristic curve was 0.803.MAR-AA was also an independent risk factor for ischemic stroke recurrence (OR=1.090,95％ CI 1.037-1.145,P=0.001).Conclusion Platelet function measured by PL-1 1 is significantly associated with higher risk of recurrent ischemic vascular events and has a greater predictive value in secondary prevention of ischemic stroke.%目的 探讨缺血性脑卒中二级预防中血小板功能与缺血性血管事件复发的相关性.方法 收集2014年9月至2015年4月发病72 h内入住威海市立医院的缺血性脑卒中患者350例.入院当日即服用阿司匹林,服用7～10d后使用PL系列多参数血小板功能分析仪(PL-1 1)检测血小板聚集率,记录患者的基线资料,并进行6个月随访,观察缺血性血管事件的复发情况.采用Logistic回归分析缺血性血管事件复发的危险因素和受试者工作特征曲线分析PL-11检测血小板聚集率对缺血性血管事件复发的预测价值.结果 在350例缺血性脑卒中患者中,随访期复发缺血性血管事件者52例,未复发缺血性血管事件者298例.与无缺血事件组比较,缺血事件组糖尿病患者比例[48.08％ (25/52)与23.15％ (69/298),x2=14.000,P＜O.01]、低密度脂蛋白胆固醇水平[(3.02±0.74) mmol/L与(2.74 ±0.72) mmol/L,t=2.410,P=0.016]、花生四烯酸诱导血小板最大聚集率(MAR-AA;27.31％ ±9.49％与18.85％±6.60％,t=6.173,P＜0.01)及肾上腺诱导血小板最大聚集率(61.26％±13.02％与51.41％±14.81％,t=4.498,P＜0.01)明显升高,是缺血性脑卒中患者缺血性血管事件复发的相对独立的危险因素,其中MAR-AA与缺血性血管事件复发关系最为密切(OR=1.133,95％ CI1.080～1.188,P＜0.01),且对缺血性血管事件复发具有较好的预测价值,其受试者工作特征曲线下面积为0.803.MAR-AA升高也是缺血性脑卒中复发的相对独立危险因素(OR=1.090,95％ CI1.037～1.145,P=0.001).结论 缺血性脑卒中二级预防中PL-11测定的血小板功能与缺血性血管事件复发密切相关,且对缺血性血管事件复发具有较好的预测价值.