大动脉粥样硬化型脑梗死急性期病人抗血小板药物抵抗的研究

THE STUDY OF ANTIPLATELET DRUGS IN PATIENTS WITH LARGE ARTERY ATHEROSCLEROTIC CEREBRAL INFARCTION

目的探讨大动脉粥样硬化型脑梗死（LAACI）急性期病人不同抗血小板药物抵抗情况及用药方案的选择。方法将230例新发LAACI病人随机分为单用阿司匹林组、阿司匹林联合氯吡格雷组。采用光学比浊法测定两组病人抗血小板药物治疗前及治疗7d后花生四烯酸（AA）、二磷酸腺苷（ADP）诱导的血小板最大聚集率（MAR）。结果两组病人初始MAR差异无显著性（P〉0．05），抗血小板药物治疗7d后MARAA、MARADP均下降，与初始MAR比较差异有统计学意义（t=17．3～96．7，P〈0．05）；两组病人MARADP，下降程度比较差异有显著性（t=16．7、16．9，P〈0．05），而MARAA下降程度差异无显著性（P〉0．05）。结论抗血小板药物治疗存在抵抗，增加阿司匹林剂量并未减少其抵抗的发生，阿司匹林、氯吡格雷联用能达到更好抑制血小板聚集的效果。

Objective To investigate different antiplatelet drugs in patients with acute large artery atherosclerotic cerebral infarction （LAACI） and the choice of medication program. Methods This study consisted of 230 patients with newly diagnosed LAACI, who were randomized to aspirin group and aspirin plus clopidogrel group. Using optics turbidimetry, arachidonic acid-induced platelet maximal aggregation rate （MARAA） and adenosine diphosphate-induced platelet maximal aggregation rate （MARADP） were detected before and seven days after therapy. Results Initially, the difference of MAR between the two groups was not significant （P〉0.05）, seven days after antiplatelet drug therapy, both MARAA and MARADP declined, which were statistically different as compared with the MAR in initial stage （t = 17.3 - 96.7, P 〈0.05）. The level of MARADP decreased significantly in both aspirin and aspirin plus clopidogrel group （t = 16.7,16.9; P 〈0.05）. There was no significant difference of MARAA between the two groups （P〉0.05）. Conclusion The antiplatelet resistant does exist, and it can＇t be conquered merely by increasing the dosage of aspirin. Combined aspirin with clopidogrel can get a better effect than aspirin alone.