血小板功能分析仪-200 P2Y结果对缺血性脑卒中患者氯吡格雷二级预防预后的评估价值

Evaluation value of platelet function analyzer-200 P2Y results for the prognosis of secondary prevention of ischemic stroke patients with clopidogrel

目的 探讨血小板功能分析仪(PFA)-200 P2Y结果对缺血性脑卒中患者氯吡格雷二级预防预后的评估价值。方法 选取2021年1~12月接受氯吡格雷进行二级预防的缺血性脑卒中患者142例,获得血液样本并使用PFA-200 P2Y测试测量闭合时间(CT),根据106 s的CT截止值将患者分为氯吡格雷反应组(A组)和氯吡格雷耐药组(B组)。对患者进行中位时间为1年的随访,记录随访期间患者发生主要不良心血管事件(MACE)的类型和时间。比较2组的基线资料、临床检验结果和发生MACE的比例。Kaplan-Meier方法描述2组的生存过程,LogRank检验比较2组的生存过程,采用多变量Cox回归模型评估分析PFA-200 P2Y结果对缺血性脑卒中患者发生MACE的关系。结果 142例患者中,24例(A组8例和B组16例)患者发生了MACE,其中缺血性脑卒中复发18例、新发短暂性脑缺血发作(TIA) 3例、心肌梗死2例、周围血管血栓或闭塞1例。B组(26.2%)较A组(9.9%)的MACE发生率增加(P<0.05)。Kaplan-Meier方法显示A组较B组中位生存时间延长69 d,LogRank检验显示2组间差异有统计学意义(P<0.05);Cox多因素风险回归分析示,CT值≤106 s(HR=4.787,95%CI:1.530~14.979)、BMI(HR=0.711,95%CI:0.565~0.896)、mRS评分(HR=1.567,95%CI:1.070~2.294)为预测MACE发生的独立危险因素(P<0.05)。结论 PFA-200 P2Y结果CT值≤106 s为缺血性脑卒中患者氯吡格雷二级预防发生MACE的独立危险因素。

Objective To investigate the value of platelet function analyzer-200(PFA)P2Y results in evaluating the prognosis of secondary prevention of ischemic stroke patients with clopidogrel.Methods A total of 142 patients with ischemic stroke who received clopidogrel for secondary prevention from January to December 2021 were selected.Blood samples were obtained and closure time(CT)was measured using PFA-200 P2Y test.All patients were allocated to the clopidogrel-response group(group A)and clopidogrel-resistant group(group B)based on a CT cut-off value of 106 seconds.Patients were followed up for a median of 1 year.The type and time of major adverse cardiovascular events(MACE)that occurred during the follow-up period were recorded.The baseline data,clinical test results and the proportion of MACE were compared between the two groups.The Kaplan-Meier method was applied to plot the survival process of the two groups,and the Log-rank test was used to compare the survival of the two groups.Multi-variate Cox regression model was used to evaluate the relationship between the result of PFA-200 P2Y and the occurrence of MACE in patients with ischemic stroke.Results Among 142 patients,24 patients(8 in group A and 16 in group B)developed MACE,including 18 cases of recurrent ischemic stroke,3 cases of newly diagnosed transient ischemic attack(TIA),2 cases of myocardial infarction and 1 case of peripheral vascular thrombosis or occlusion.The incidence of MACE in the clopidogrel-resistant group was significantly higher than that in the clopidogrel-response group(26.2%vs 9.9%,P<0.05).The Kaplan-Meier method showed that the median survival time of the clopidogrel-response group was 69 days,significantly longer than that of the clopidogrel-resistant group,and the Log-rank test showed that the difference between the two groups was significant(P<0.05).Multi-variate Cox risk regression analysis indicated that CT value≤106 s(HR=4.787,95%CI:1.530-14.979),body mass index(BMI)(HR=0.711,95%CI:0.565-0.896)and modified Rankin Scale(mRS)score(HR=1.567,95%CI:1.070-2.294)were independent risk factors for predicting the occurrence of MACE(P<0.05).Conclusion The CT value of PFA-200 P2Y≤106 seconds is an independent risk factor for the occurrence of MACE in secondary prevention of ischemic stroke with clopidogrel.