复发性脑梗死患者氯吡格雷抵抗相关因素分析及治疗对策

Analysis and treatment of clopidogrel resistance in patients with recurrent cerebral infarction

目的通过分析发生氯吡格雷抵抗的复发性脑梗死患者临床资料及替格瑞洛替代治疗的疗效,探索可能导致氯吡格雷抵抗发生的原因及治疗办法。方法选择急性复发性脑梗死患者178例,根据二磷酸腺苷(ADP)诱导的血小板抑制率分为氯吡格雷抵抗组76例及敏感组102例,行脑梗死相关危险因素比较。氯吡格雷抵抗组根据氯吡格雷基因型(CYP2C19)检测分为氯吡格雷治疗组(氯吡格雷75mg, 2次/d)及替格瑞洛治疗组(替格瑞洛90mg, 2次/d),治疗前及治疗后2周行ADP诱导的血小板抑制率、神经功能缺损评分(NIHSS)的比较。数据均应用SPSS 17.0软件进行分析。结果 (1)氯吡格雷抵抗组糖尿病、睡眠呼吸暂停低通气综合征(OSAHS)、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)较敏感组增高,差异有统计学意义(P<0.05);(2)治疗后替格瑞洛组血小板抑制率(37.89±7.71)%高于治疗前(21.58±4.82)%及氯吡格雷组治疗后(23.55±4.88)%,差异有统计学意义(P<0.05);替格瑞洛组NIHSS评分(7.87±5.94)分低于治疗前(13.15±8.26)分及氯吡格雷组治疗后(10.25±6.16)分,差异有统计学意义(P<0.05)。结论 (1)复发性脑梗死患者氯吡格雷抵抗的发生可能与糖尿病、OSAHS及高水平的LDL-C有关;(2)替格瑞洛替代治疗氯吡格雷抵抗可有效抑制ADP诱导的血小板聚集,改善神经功能缺损程度。

Objective To explore the possible cause and treatment of clopidogrel resistance by observing the occurrence of clopidogrel resistance of recurrent cerebral infarction and curative effect of ticagrelor while ticagrelor is used to replace clopidogrel for clopidogrel resistance occurs.Methods A total of 178 cases were chosen from acute recurrent cerebral infarction patients, and according to the detected ADP-induced platelet inhibition rate, they were classified into clopidogrel resistance group(76 cases) and sensitive groups(102 cases).The risk factors associated with cerebral infarction in two groups were compared.The clopidogrel resistance group was divided into clopidogrel treatment group(clopidogrel 75 mg, twice/d) and ticagrelor treatment group(ticagrelor 90 mg, twice/d). ADP-induced platelet inhibition and NIHSS scores were compared before and 2 weeks after treatment.Data were analyzed by SPSS 17.0 software.Results(1)Diabetes, sleep apnea hypopnea syndrome(OSAHS),glycosylated hemoglobin(HbA1 c) and low-density lipoprotein cholesterol(LDL-C) that occurred in clopidogrel resistance group were more than in sensitive group, and differences were significantly(P<0.05).(2)After treatment, the platelet inhibition rate(37.89±7.71) in the ticagrelor group was significantly higher than that before treatment(21.58±4.82) and it was also higher than that in the clopidogrel group(23.55±4.88). Differences were significantly(P<0.05).(3)The NIHSS score(7.87±5.94) in the treatment group was lower than that before the treatment(13.15±8.26) and that in the clopidogrel group after the treatment(10.25±6.16).Differences were significantly(P<0.05).Conclusion The occurrence of clopidogrel resistance in patients with recurrent cerebral infarction may be related to diabetes mellitus, OSAHS and high levels of HbA1 c and LDL-C.In the treatment, using ticagrelor as a replacement for clopidogrel can effectively inhibit ADP-induced platelet aggregation and improve the degree of neurological deficits.