脑梗死患者抗血小板二级预防后再发脑梗死的类型及危险因素分析

Analysis of ischemic subtypes and risk factors of recurrence of ischemic stroke patients using antiplatelet drugs

目的:探讨脑梗死患者抗血小板药物进行二级预防后再发脑梗死的类型及其危险因素。方法:回顾性收集我院130例服用抗血小板药物后再发脑梗死患者(抗血小板组),101例未服用抗血小板药物再发脑梗死患者(未抗血小板组),对两组患者进行脑梗死分型,分析不同类型脑梗死的危险因素。结果:(1)单因素分析显示:抗血小板组再发腔隙性脑梗死(LI)患者中合并冠心病、吸烟的比例高于未抗血小板组LI患者(P<0.05);抗血小板组再发动脉粥样硬化性血栓形成(AT)患者中合并冠心病、糖尿病、高低密度脂蛋白的比例显著高于未抗血小板组AT患者(P<0.05)。(2)多因素分析显示:抗血小板组再发LI合并冠心病、吸烟是其再发脑梗死的独立危险因素(P=0.018,P=0.027);抗血小板组再发AT合并糖尿病、冠心病、高低密度脂蛋白血症是其独立危险因素(P=0.003,P=0.010,P=0.002)。结论:合并冠心病、吸烟是抗血小板二级预防后再发LI的独立危险因素;合并糖尿病、冠心病、高低密度脂蛋白血症是抗血小板二级预防后再发AT的独立危险因素。合并冠心病多血管床病变会增加LI和AT的复发。

Objective To explore types and risk factors of recurrent ischemic stroke in ischemic stroke patients using antiplatelet drugs. Methods By retrospective study, 130 recurrent ischemic stroke patients using antiplatelet drugs （antiplatelet therapy group） and 101 recurrent ischemic stroke patients not taking antiplatelet drugs （non antiplatelet therapy group） were collected. Two groups of patients were divided according to the ischemic subtypes, and risk factors between different subtypes were analyzed. Results （1） Single factor analysis showed history of coronary heart disease and smoking are more frequent in antiplatelet therapy group with recurrent lacunar infarction （LI）. History of coronary heart disease, diabetes, and high level of low density lipoprotein （LDL） are more frequent in antiplatelet therapy group suffer from recurrent atherosclerotic thrombosis （AT）. （2）Logistic regression analysis showed the history of coronary heart disease , smoking are independent risk factors for recurrent LI in antiplatelet therapy group （P = 0.018, P = 0.027）; history of coronary heart disease, diabetes, and high level of LDL are independent risk factors for recurrent AT in antiplatelet therapy group （P =0.003, P = 0.010, P = 0.002）. Conclusions The history of coronary heart disease and smoking are independent risk factors for the recurrence of LI in patients with antiplatelet therapy. History of coronary heart disease , diabetes , and high level of LDL are independent risk factors for the recurrence of AT in patients with antiplatelet therapy. Combined coronary heart disease would increase both LI and AT recurrence.