阿托伐他汀对急性缺血性卒中患者血小板反应性的影响

Effect of atorvastatin on platelet reactivity in patients with acute ischemic stroke

目的探讨阿托伐他汀对急性缺血性卒中患者治疗期间血小板高反应性(high on-treatment platelet reactivity,HTPR)的影响。方法前瞻性纳入天津医科大学第二医院神经内科在2021年9月至2023年6月期间收治的急性缺血性卒中患者。收集患者人口统计学特征和基线临床资料。通过光比浊法评估血小板反应性,HTPR定义为二磷酸腺苷诱导的血小板最大聚集率(maximum aggregation rate,MAR)≥47%。应用多变量logistic回归分析确定阿托伐他汀与HTPR的独立相关性。结果共纳入253例患者,男性152例,年龄(69.97±11.319)岁,86例(34.0%)患者存在HTPR,155例(61.3%)服用阿托伐他汀(20 mg/d)。非HTPR组男性患者构成比、收缩压、舒张压以及红细胞计数显著高于HTPR组(P均<0.05)。阿托伐他汀组MAR显著低于其他他汀类药物组(P<0.01)。多变量logistic回归分析显示,校正混杂因素后,阿托伐他汀(优势比0.500,95%置信区间0.285~0.879;P=0.016)和女性(优势比1.966,95%置信区间1.108~3.489;P=0.021)与急性缺血性卒中患者HTRP显著独立相关。结论接受阿托伐他汀联合抗血小板药治疗可有效减少急性缺血性卒中患者HTPR。

Objective To investigate the effect of atorvastatin on high on-treatment platelet reactivity(HTPR)in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Department of Neurology,the Second Hospital of Tianjin Medical University between September 2021 and June 2023 were prospectively included.The demographic characteristics and baseline clinical data were collected.Platelet reactivity was assessed by light transmittance aggregometry,and HTPR was defined as the maximum aggregation rate(MAR)of platelets induced by adenosine diphosphate≥47%.Multivariate logistic regression analysis was used to determine the independent correlation between atorvastatin and HTPR.Results A total of 253 patients were enrolled,including 152 males,aged 69.97±11.319 years.Eighty-six patients(34.0%)had HTPR,and 155 patients(61.3%)took atorvastatin(20 mg/d).Systolic blood pressure,diastolic blood pressure,red blood cell count and the proportion of male patients in the non-HTPR group were significantly higher than those in the HTPR group(all P<0.05).The MAR of the atorvastatin group was significantly lower than that of other statin drug groups(P<0.01).Multivariate logistic regression analysis showed that after adjusting for confounding factors,atorvastatin(odds ratio 0.500,95%confidence interval 0.285-0.879;P=0.016)and female(odds ratio 1.966,95%confidence interval 1.108-3.489;P=0.021)were significantly independently associated with HTRP in patients with acute ischemic stroke.Conclusion Receiving atorvastatin combined with antiplatelet therapy can effectively reduce HTPR in patients with acute ischemic stroke.