脑梗死患者氯吡格雷抵抗及其与90天时血管事件的相关性

Association between clopidogrel resistance and ischemic vascular events in cerebral infarction patients on day 90 after treatment

目的探讨用氯吡格雷的脑梗死患者氯吡格雷抵抗（CR）发生率,CR与90d时脑梗死复发及其他血管事件的相关性。方法 515例脑梗死患者服氯吡格雷前和7-10d后,测血小板聚集率,筛选CR 203例（CR组）及氯吡格雷敏感（CS组）312例,患者出院后仍服氯吡格雷,随访90d。原发终点为缺血性血管事件复合终点,次要终点为改良的Rankin量表（mRS）评分。logistic回归分析CR发生的危险因素,Cox比例风险分析缺血性血管事件发生的危险因素。结果糖尿病（OR=2.36,95%CI：1.24-4.98,P=0.00）是CR发生的独立危险因素。随访期,CR组总缺血性血管事件（12.3%vs 4.8%）和脑梗死复发率高于CS组（8.4%vs 1.9%）;mRS评分0-2分比例低于CS组（67.5%vs 79.8%,P〈0.01）。CR（RR=2.88,95%CI：1.28-6.92,P=0.00）、糖尿病（RR=1.59,95%CI：1.02-3.48,P=0.00）、高血压（RR=1.86,95%CI：1.16-4.69,P=0.00）是缺血性血管事件发生的独立危险因素。结论用氯吡格雷脑梗死患者CR发生率高,CR与缺血性血管事件、脑梗死复发和神经功能恢复密切相关。

Objective To study the association between clopidogrel resistance（CR）and ischemic vascular events in cerebral infarction patients on day 90 after treatment.Methods The platelet aggregation rate was assayed in 515 cerebral infarction patients before and 7-10days after clopidogrel treatment.The patients were divided into CR group（n=203）and clopidogrel sensitive（CS）group（n=312）.The patients going on clopidogrel treatment after discharge were followed up for 90 days.The primary endpoint was a composite endpoint of ischemic vascular events,the second endpoint was the mRS score on day 90 after treatment.The risk factors for CR and ischemic vascular events were analyzed by logistic regression analysis and Cox proportional model respectively.Results Diabetes mellitus（DM）was the independent risk factor for CR（OR=2.36,95%CI：1.24-4.98,P=0.00）.The incidence of ischemic vascular events and recurrent cerebral infarction was significantly higher whereas the mRS score（0-2）was significantly lower in CR group than in CS group.CR,DM,and hypertension were the risk factors for ischemic vascular events（RR=2.88,95%CI：1.28-6.92,P=0.00;RR=2.36,95%CI：1.24-4.98,P=0.00;RR=1.86,95%CI：1.16-4.69,P=0.00）.Conclusion The incidence of CR is high in cerebral infarction patients after clopidogrel treatment.CR is closely associated with ischemic vascular events,recurrent cerebral infarction and restored neurological function.