缺血性脑卒中患者氯吡格雷抵抗与颈动脉狭窄的相关性分析

摘要

目的：探讨缺血性脑卒中患者氯吡格雷抵抗与颈动脉狭窄的相关性。方法比浊法测定缺血性脑卒中患者服用氯吡格雷（75 mg／d）前及服用2周后血小板聚集率变化。根据血小板聚集率变化将病例分为氯吡格雷抵抗（clopidogrel re‐sistance ，CR）组和氯吡格雷敏感（clopidogel sensitivity ，CS）组。比较CR组和CS组相关的临床数据，并使用多变量Logistic回归分析确定CR的独立危险因素。结果228例缺血性脑卒中患者，其中CR组54例（23.68％），CS组174例（76.32％）。单因素分析结果显示：年龄（P＝0.015）、血小板数量（P＝0.012）、中度颈动脉狭窄（P＝0.034）、性别（P＝0.049）和糖尿病（P＝0.032）在CR组和CS组中均存在显著差异。多因素Logistic分析结果显示，年龄（P＝0.004）、血小板数量（P＝0.025）、糖尿病（P＝0.026）、中度颈动脉狭窄（P＝0.002）是CR发生的独立危险因素。结论缺血性脑卒中患者CR与多种因素相关，其中中度颈动脉狭窄是CR的独立危险因素之一。%Objective To investigate the correlation between clopidogrel resistance (CR) and carotid artery stenosis in patients with ischemic stroke .Methods Turbidimetry was used to measure the changes of platelet aggregation rate after the included patients with ischemic stroke taking 75 mg of clopidogrel per day for two weeks .The patients were divided into either CR or clopidogrel sensitivity (CS) group according to the changes of platelet aggregation rate .The demographic and clinical da‐ta of both groups were compared .Multivariate logistic regression analysis was used to identify the independent risk factors for CR .Results A total of 228 patients with ischemic stroke were included ,among whom 54 cases (23.68% ) were in the CR group and 174(76.32% ) were in the CS group .Single factor analysis showed that there were statistical differences between the two groups in terms of age(P=0.015) ,platelet count(P=0.012) ,moderate carotid stenosis(P=0.034) ,gender(P=0.049) and diabetes(P=0.032) .Multiariable logistic analysis results presented that age(P=0.004) ,platelet count(P=0.025) ,diabe‐tes(P=0.026) and moderate carotid stenosis(P=0.002) were the independent risk factors for CR .Conclusion CR existing in patients with ischernic stroke may be associated with a variety of factors ,in which moderate carotid artery stenosis is one of the risk factors for CR .