脑梗死二级预防阿司匹林抵抗高危因素及氯吡格雷干预效果分析

High-Risk Factors of Resistance to Aspirin Used in Secondary Prevention of Cerebral Infarction and the Intervention Effect of Clopidogrel

目的分析阿司匹林用于脑梗死二级预防时发生抵抗的高危因素及氯吡格雷的干预效果。方法选取医院2015年1月至2017年6月收治的脑梗死患者120例,以血小板聚集率为基础,分为阿司匹林抵抗组(A组)和阿司匹林未抵抗组(B组),各60例,分析发生阿司匹林抵抗的高危因素。按随机数字表法将阿司匹林抵抗组患者分为A1组和A2组,各30例。两组患者均继续口服阿司匹林片,B组患者加服硫酸氢氯吡格雷片。结果单因素及多因素Logistic回归分析显示,年龄、糖尿病、高低密度脂蛋白(LDL)血症是脑梗死二级预防中发生阿司匹林抵抗的高危因素(P<0.05);与治疗前比较,A1组和A2组患者治疗后的肢体运动功能(FMA)评分及日常生活能力(Barthel)评分均显著增加,美国国立卫生研究院卒中量表(NIHSS)评分显著减少,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著延长,神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、S100β蛋白及D-二聚体含量均显著减少(P<0.05),且A2组患者各项指标的改善程度均显著优于A1组(P<0.05);A2组患者缺血性不良事件发生率为6.67%,显著低于A1组的20.00%(P<0.05)。结论年龄、性别、糖尿病、高LDL血症是脑梗死患者二级预防中发生阿司匹林抵抗的高危因素,加用氯吡格雷治疗可有效改善抵抗现象,减少缺血性不良事件发生。

Objective To analyze the high-risk factors of resistance to aspirin used in secondary prevention of cerebral infarction and the intervention effect of clopidogrel.Methods Totally 120 patients with cerebral infarction admitted to our hospital from January 2015 to June 2017 were selected and divided into aspirin resistant group(group A)and aspirin non-resistant group(group B)according to platelet aggregation rate,60 cases in each group.The patients in the aspirin resistance group were divided into group A1 and group A2 according to the random number table method,30 cases in each group.The patients in the two groups continued to take aspirin orally,on this basis,the patients in group B were given Clopidogrel Sulfate Tablets.Results Single factor and multi factor Logistic regression analysis showed that age,diabetes mellitus and high low-density lipoprotein(LDL)were the high-risk factors of aspirin resistance in secondary prevention of cerebral infarction(P<0.05).Compared with those before treatment,the scores of Fugel-Meyer(FMA)and barthel index(Barthel)were significantly increased,the score of the National Institutes of Health Stroke Scale(NIHSS)was significantly decreased,the prothrombin time(PT)and activated partial thromboplastin time(APTT)were significantly prolonged,the levels of neuron-specific enolase(NSE),myelin basic protein(MBP),S100β and D-dimer were significantly decreased in group A1 and group A2(P<0.05),and the improvement of each index in group A2 was significantly better than that in group A1(P<0.05).The incidence of ischemic adverse events in group A2 was 6.67%,which was significantly lower than 20.00% in group A1(P<0.05).Conclusion Age,sex,diabetes mellitus and high LDL are the high-risk factors for aspirin resistance in secondary prevention of cerebral infarction.Clopidogrel therapy can effectively improve resistance and reduce the incidence of ischemic adverse events.