2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的危险因素研究

Risk factors associated with clopidogrel resistance in type 2 diabetes mellitus patients with cerebral infarction

目的探讨2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的危险因素。方法纳入112例2型糖尿病合并脑梗死患者,根据血小板聚集率将患者分为试验组(氯吡格雷抵抗组,25例)和对照组(氯吡格雷非抵抗组,87例)。2组患者持续口服硫酸氢氯吡格雷75 mg至少7 d,详细记录患者基本资料并进行美国国立卫生研究院卒中量表(NIHSS)评分和Alberta卒中项目早期电子计算机断层扫描(ASPECT)评分,用腺苷二磷酸(ADP)诱导光比浊法测定血小板聚集功能,并分析其相关性。结果试验组和对照组NIHSS评分分别为(3.91±4.95),(2.40±2.09)分,ASPECT评分分别为(11.57±6.05),(13.40±1.29)分,差异均有统计学意义(均P<0.05)。结论脑梗死严重程度及脑梗死面积是2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的风险因素,脑梗死程度越严重、梗死面积越大在使用氯吡格雷进行二级预防时,对氯吡格雷抗血小板疗效的敏感性较低,需及时调整方案。

Objective To investigate the risk factors of clopidogrel resistance in type 2 diabetes mellitus and cerebral infarction patients. Methods A total of 112 patients were divided into treatment group （clopidogrel resistant group, n = 25 ） and control group （clopidogrel non - resistant group, n = 87 ） according to the platelet aggregation. All the patients were taken clopidogrel 75 mg daily at least 7 d. The general data of the patients were recorded. The National institute of health stroke scale （NIHSS） and Alberta stroke program early computed tomography （ASPECT） score were recorded in two groups. The platelet aggregation function were analyzed by adenosine diphosphate （ADP） induced optical turbid metric method and analyze their correlation. Results The NIHSS in treatment group and control group were （3.91± 4.95 ）, （2.40 ± 2. 09 ） point, the ASPECT score in treatment group and control group were （ 11.57±6.05）, （ 13.40± 1.29 ） point, with significant difference （P 〈 0. 05）. Conclusion Clopidogrel resistance is associated with increased clinical severity and infarct volume in type 2 diabetes mellitus and cerebral infarction patients.