非致残性缺血性脑血管事件病人氯吡格雷抵抗的临床相关因素分析

Clinical related factors of clopidogrel resistance in patients with non-disabled ischemic cerebrovascular events

目的探讨非致残性缺血性脑血管事件(NICE)病人氯吡格雷抵抗的临床相关因素。方法连续收集2019年1―10月徐州医科大学附属医院神经内科收治的165例非致残性缺血性脑血管事件病人,并且给予阿司匹林联合氯吡格雷治疗,7~10 d后采用血栓弹力图检测其血小板抑制率。将二磷酸腺苷(ADP)诱导的血小板聚抑制率≤30%定义为氯吡格雷抵抗(CR)。比较人口统计学、血管危险因素、实验室检查等临床资料,采用logistic多因素回归分析氯吡格雷抵抗的相关因素。结果NICE病人,34例(20.6%)发生氯吡格雷抵抗。logistic模型分析显示,hs-CRP(OR1.143,95%CI:1.024~1.276;P=0.017)、PLR(OR1.014,95%CI:1.005~1.022;P=0.002)、Hcy(OR1.12795%CI:1.046~1.215;P=0.002)是氯吡格雷抵抗的独立相关因素。结论hs-CRP、PLR、Hcy是非致残性缺血性脑血管事件病人氯吡格雷抵抗的独立相关因素。

Objective To investigate clinical related factors of clopidogrel resistance in patients with non-disabled ischemic cerebrovascular events(NICE).Methods One hundred and sixty-five patients with non-disabled ischemic cerebrovascular events admitted to the Department of Neurology,Affiliated Hospital of Xuzhou Medical University from January to October 2019 were continuously collected,All patients were treated with aspirin and clopidogrel therapy.The platelet inhibition rate was recorded by thromboelastography after 7-10 days.The ADP-induced platelet inhibition rate≤30%was defined as clopidogrel resistance(CR).The clinical data of demographics,vascular risk factors,laboratory examination were compared.Multivariate logistic regression analysis was used to analyze the related factors of clopidogrel resistance.Results Patients with non-disabled ischemic cerebrovascular events,34 patients(20.6%)developed clopidogrel resistance.Multivariate logistic regression analysis showed that hs-CRP(OR 1.143,95%CI:1.024-1.276;P=0.017),PLR(OR 1.014,95%CI:1.005-1.022;P=0.002),Hcy(OR 1.12795%CI:1.046-1.215;P=0.002)were independently relevant factors of C.R.Conclusion hs-CRP,PLR and Hcy are independently relevant factors of CR in patients with NICE.