阿司匹林用于脑梗死二级预防中发生抵抗的原因分析及氯吡格雷干预效果研究

Reason analysis of drug resistance of aspirin applied to secondary prevention of cerebral infarction and study of intervention effect of clopidogrel

目的分析阿司匹林用于脑梗死二级预防中发生抵抗的原因及氯吡格雷干预效果。方法选择2014年1月—2015年9月256例脑梗死患者纳入研究对象,所有患者均于入院当日开始服用阿司匹林,服用7d后检测血小板聚集率,筛选出阿司匹林抵抗(AR)及阿司匹林半抵抗(ASR)患者共62例,分析引起AR相关因素。采用随机数字表法将62例AR患者分为观察组和对照组各31例,对照组继续服用阿司匹林治疗,观察组服用氯吡格雷联合阿司匹林治疗,观察两组患者血小板聚集率变化、再发脑梗死及出血情况。结果 256例脑梗死患者中,发生AR 62例,发生率24.22%。AR+ASR组患者女性、合并糖尿病、低密度脂蛋白(LDL)水平均明显高于阿司匹林敏感(AS)组(t/χ~2=4.396,4.083,11.191,P<0.05);治疗7d、14d后,观察组血小板聚集率均明显低于对照组(t=10.578,10.466,P<0.05);随访6个月(2014年7月—2016年3月)和12个月(2014年12月-2016年8月),观察组再发梗死率均明显低于对照组(3.23%vs19.38%,3.23%vs22.58%)(χ~2=4.026,5.167,P<0.05)。结论女性、糖尿病、高低密度脂蛋白是脑梗死二级预防中发生AR的高危因素,氯吡格雷联合阿司匹林治疗能降低血小板聚集率,预防脑梗死复发。

Objective To analyze the reason for drug resistance of aspirin applied to secondary prevention of cerebral infarction and intervention effect of clopidogrel. Method A total of two hundred and fifty-six cases of patients with cerebral infarction admitted to our hospital from January 2014 to September 2015 were selected and included into objects of study. All patients began to take aspirin on admission day. After 7 days of drug administration, the plalelet aggregation rate was measured, a total of sixty-two cases of patients with aspirin resistance （ AR ） or aspirin semi-resistance （ ASR ） were screened, and relevant factors giving rise to AR were analyzed. The sixty-two cases of patients were randomly divided into observation group and control group according to the random number table method,with thirty-one cases in each group. Patients in the control group continued to take aspirin, and those in the observation group took clopidogrel in combination with aspirin. Changes in platelet aggregation rate, relapse of cerebral infarction and hemorrhage of patients in the two groups were observed. Results Among the two hundred and fifty-six cases of patients with cerebral infarction, sixty-two cases were attacked by AR, and the incidence rate was 24.22%. Female, diabetes and level of low density lipoprotein （ LDL ） in patients in AR Group and ASR Group were significantly higher than in aspirin sensitive （ AS ） group （ tx 2=4.396, 4.085, 11.191, P〈0.05 ） ; at 7d and 14d after treatment, the platelet aggregation rate in the observation group was significantly lower than that in the control group （ t=10.578, 10.466, P〈0.05 ） ; after 6 months （ July 2014 to March 2016 ） and 12 months （ December2014 to August 2016 ） of follow-up visit, recurrent cerebral infarction rate in patients in the observation group was significantly lower than in the control group （ 3.23% vs 19.38%, 3.23% vs 22.58% ）（ X 2=4.026, 5.167, P〈0.05 ） . Conclusion Female, diabetes and high and low density lipoprotein are high risk factors causing AR in secondary prevention of cerebral infarction. Clopidogrel in combination with aspirin therapy can reduce platelet aggregation rate and prevent the relapse of cerebral infarction.