抗血小板药物抵抗的个体化治疗在预防缺血性脑卒中再发作中的应用研究

The Application of Individualized Treatment of Antiplatelet Drug Resistance in the Prevention of Ischemic Stroke

目的研究抗血小板药物的个体化治疗方案对缺血性脑卒中再发作的预防作用,为缺血性脑卒中的治疗及抗血小板药物抵抗的处理提供理论依据。方法收集我院TIA和轻型卒中患者共223人,记录患者入院的血小板最大聚集率(MAR%)。入院当天给予阿司匹林+氯吡格雷,治疗7日后根据血栓弹力图结果将患者分为抗血小板药物抵抗组(试验组87人)与无抵抗组(对照组136人)。予试验组调整药物为西洛他唑+波立维;对照组继续阿司匹林+氯吡格雷治疗。治疗一年后再次记录两组平均MAR%,比较两组缺血性脑卒中的再发作率有无差异。结果试验组与对照组在治疗后相比于治疗前其MAR%均显著降低(P<0.05),且试验组相比于对照组其MAR%降低更为明显(P<0.05)。此外,相比于对照组(5.88%),实验组的缺血性脑卒中的再发作率(2.30%)显著降低,该差异具有统计学意义(P<0.05)。结论对缺血性脑卒中患者行个体化抗血小板治疗可有效改善抗血小板药物抵抗,并降低缺血性脑卒中的再发率。

Objective To explore the preventive effect of individualized treatment of antiplatelet drugs on recurrent attack of ischemic stroke, and provide theoretical basis for the treatment of ischemic stroke and the treatment of antiplatelet drug resistance. Methods A total of 223 TIA and mild stroke patients in our hospital were collected. The level of MAR% was recorded. On the day of admission, patients were given aspirin plus clopidogrel, 7 days after treatment, according to the results of Thrombelastogram, patients were divided into antiplatelet drug resistance group（experimental group 87） and non-resistance group（control group 136）. Drugs of experimental group were adjusted to cilostazol ＋ Plavix, and the control group continued the treatment of aspirin plus clopidogrel. After one year, the average MAR% of the two groups was recorded again. Results The levels of MAR% in both experimental group and control group after treatment were significantly lower than those before treatment（P〈0.05）, and the decrease of MAR% in the experimental group was more obvious than that in the control group（P〈0.05）. In addition, compared with the control group（5.88%）, the recurrence rate of ischemic stroke in the experimental group was significantly lower than that in the control group（2.30%）, and the difference was statistically significant（P〈0.05）. Conclusion Individualized antiplatelet therapy for patients with ischemic stroke can effectively improve the resistance to antiplatelet drugs and reduce the recurrence rate of ischemic stroke.