抗血小板药抵抗与卒中防治

Antiplatelet agent resistance and prevention and treatment of stroke

大量研究证实，抗血小板药能使卒中、心肌梗死或死亡的相对危险度平均降低22％。然而，许多患者在服用抗血小板药期间仍出现血栓形成事件，这被称为“抗血小板药抵抗”。其发生率各家报道差异很大，阿司匹林抵抗的发生率为3％～85％，氯吡格雷抵抗的发生率为28％～44％。抗血小板药抵抗的确切原因尚不清楚，可能与药物生物利用度下降、基因多态性、其他血小板激活通路被激活、循环血小板增加等多种因素有关。目前，已有多种实验室检查方法被用于抗血小板药抵抗的检测，其标准各不相同。此外，抗血小板药抵抗的应对措施亦无定论，给卒中防治带来更大的困难。

A large number of studies have confirmed that antiplatelet agents reduce the relative risk of stroke, myocardial infarction, or death by an average of 22%. However, many patients still have thrombotic events during the period of taking anti-platelet agents, and this is called ＂anti-platelet agent resistance＂. Its incidences reported are very different. The incidence of aspirin is 3% to 85%, and that of clopidogrel is 28% to 44%. The exact cause of antiplatelet agent resistance remains unclear. It may be associated with several factors, including decreased drug bioavailability, genetic polymorphisms, activation of other platelet activation pathways, and increased circulating platelets. Currently, a variety of laboratory methods have been used to detect antiplatelet agent resistance, its criteria are different. In addition, the response measures of antiplatelet agent resistance also have no conclusion, and this has brought greater difficulties for the prevention and treatment of stroke.