国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2012年
6期
423-427
,共5页
石红婷%周伯荣%王融%邓燕华%关海涛%刘子凡
石紅婷%週伯榮%王融%鄧燕華%關海濤%劉子凡
석홍정%주백영%왕융%산연화%관해도%류자범
缺血性卒中%氯吡格雷抵抗%血小板聚集%影响因素
缺血性卒中%氯吡格雷牴抗%血小闆聚集%影響因素
결혈성졸중%록필격뢰저항%혈소판취집%영향인소
Drug Resistance%Platelet Aggregation Inhibitors%Clopidogrel%Stroke%Brain Ischemia%Risk Factors
目的 探讨缺血性卒中患者中氯吡格雷抵抗(clopidogrel resistance,CR)的危险因素.方法 急性缺血性卒中患者服用氯吡格雷(75 mg/d)10～ 14 d后采用光比浊法测定血小板聚集率变化.根据血小板聚集率变化将病例分为CR组和氯吡格雷敏感(clopidogrel sensitivity,CS)组,比较两组的人口统计学和临床资料,并采用多变量 logistic回归分析确定CR的独立危险因素.结果 共纳入147例急性缺血性卒中患者,其中CR 组42例(28.57％),CS组105例(71.43％).CR组糖尿病(54.76％对11.43％;x2=31.054,P=0.000)、既往短暂性脑缺血发作(transient ischemic attack,TIA)史(80.95％对 26.67％; x2=36.251,P=0.000)或经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)史(26.19％对3.81％；x2=16.400.P=0000)、服用钙通道阻滞药(calcium channel blocker,CCB)(83.33％对54.29％；x2=10.810,P=0.001)、血管紧张素转换酶抑制药(angiotensin converting enzyme inhibitor,ACEI)/血管紧张素受体阻滞药(angiotensin receptor blocker,ARB)(66.67％对42.86％;x2=6.803.P=0.009)和质子泵抑制药(47.62％对14.29％;x2=18.375,P=0.000)的患者比例以及血浆总胆固醇[(5.23±1.07) mmol/L对(4.60±1.11) mmol/L；t=3.121.P=0.002]、血糖浓度[(6.65±2.19)mmol/L对(5.43±1.15)mmol/L;t=3.442.P=0.001]和糖化血红蛋白水平[ (6.40±1.42)％对(5.48±1.09)％;t=3.780,P=0.000]均显著高于CS组.多变量logistic 回归分析显示,糖尿病[优势比(odds ratio,OR) 13.711,95％可信区间(confidence interval,CI)1.667～112.784;P =0.015]、总胆固醇增高(OR2.828,95％ CI1.574～5.080;P =0.001)、既往TIA史(OR16.627,95％ CI4.691～58.934;P =0.000)以及长期服用CCB( OR 4.147,95％ CI1.053～16.332；P=0.042)、ACEI/ARB( OR 4.841,95％ CI 1.539～15.231;P=0.007)为CR的独立危险因素.结论 缺血性卒中患者的CR与多种因素有关,其中糖尿病、总胆固醇增高以及长期服用 CCB和ACEI/ARB是CR的独立危险因素.
目的 探討缺血性卒中患者中氯吡格雷牴抗(clopidogrel resistance,CR)的危險因素.方法 急性缺血性卒中患者服用氯吡格雷(75 mg/d)10～ 14 d後採用光比濁法測定血小闆聚集率變化.根據血小闆聚集率變化將病例分為CR組和氯吡格雷敏感(clopidogrel sensitivity,CS)組,比較兩組的人口統計學和臨床資料,併採用多變量 logistic迴歸分析確定CR的獨立危險因素.結果 共納入147例急性缺血性卒中患者,其中CR 組42例(28.57％),CS組105例(71.43％).CR組糖尿病(54.76％對11.43％;x2=31.054,P=0.000)、既往短暫性腦缺血髮作(transient ischemic attack,TIA)史(80.95％對 26.67％; x2=36.251,P=0.000)或經皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)史(26.19％對3.81％；x2=16.400.P=0000)、服用鈣通道阻滯藥(calcium channel blocker,CCB)(83.33％對54.29％；x2=10.810,P=0.001)、血管緊張素轉換酶抑製藥(angiotensin converting enzyme inhibitor,ACEI)/血管緊張素受體阻滯藥(angiotensin receptor blocker,ARB)(66.67％對42.86％;x2=6.803.P=0.009)和質子泵抑製藥(47.62％對14.29％;x2=18.375,P=0.000)的患者比例以及血漿總膽固醇[(5.23±1.07) mmol/L對(4.60±1.11) mmol/L；t=3.121.P=0.002]、血糖濃度[(6.65±2.19)mmol/L對(5.43±1.15)mmol/L;t=3.442.P=0.001]和糖化血紅蛋白水平[ (6.40±1.42)％對(5.48±1.09)％;t=3.780,P=0.000]均顯著高于CS組.多變量logistic 迴歸分析顯示,糖尿病[優勢比(odds ratio,OR) 13.711,95％可信區間(confidence interval,CI)1.667～112.784;P =0.015]、總膽固醇增高(OR2.828,95％ CI1.574～5.080;P =0.001)、既往TIA史(OR16.627,95％ CI4.691～58.934;P =0.000)以及長期服用CCB( OR 4.147,95％ CI1.053～16.332；P=0.042)、ACEI/ARB( OR 4.841,95％ CI 1.539～15.231;P=0.007)為CR的獨立危險因素.結論 缺血性卒中患者的CR與多種因素有關,其中糖尿病、總膽固醇增高以及長期服用 CCB和ACEI/ARB是CR的獨立危險因素.
목적 탐토결혈성졸중환자중록필격뢰저항(clopidogrel resistance,CR)적위험인소.방법 급성결혈성졸중환자복용록필격뢰(75 mg/d)10～ 14 d후채용광비탁법측정혈소판취집솔변화.근거혈소판취집솔변화장병례분위CR조화록필격뢰민감(clopidogrel sensitivity,CS)조,비교량조적인구통계학화림상자료,병채용다변량 logistic회귀분석학정CR적독립위험인소.결과 공납입147례급성결혈성졸중환자,기중CR 조42례(28.57％),CS조105례(71.43％).CR조당뇨병(54.76％대11.43％;x2=31.054,P=0.000)、기왕단잠성뇌결혈발작(transient ischemic attack,TIA)사(80.95％대 26.67％; x2=36.251,P=0.000)혹경피관상동맥개입치료(percutaneous coronary intervention,PCI)사(26.19％대3.81％；x2=16.400.P=0000)、복용개통도조체약(calcium channel blocker,CCB)(83.33％대54.29％；x2=10.810,P=0.001)、혈관긴장소전환매억제약(angiotensin converting enzyme inhibitor,ACEI)/혈관긴장소수체조체약(angiotensin receptor blocker,ARB)(66.67％대42.86％;x2=6.803.P=0.009)화질자빙억제약(47.62％대14.29％;x2=18.375,P=0.000)적환자비례이급혈장총담고순[(5.23±1.07) mmol/L대(4.60±1.11) mmol/L；t=3.121.P=0.002]、혈당농도[(6.65±2.19)mmol/L대(5.43±1.15)mmol/L;t=3.442.P=0.001]화당화혈홍단백수평[ (6.40±1.42)％대(5.48±1.09)％;t=3.780,P=0.000]균현저고우CS조.다변량logistic 회귀분석현시,당뇨병[우세비(odds ratio,OR) 13.711,95％가신구간(confidence interval,CI)1.667～112.784;P =0.015]、총담고순증고(OR2.828,95％ CI1.574～5.080;P =0.001)、기왕TIA사(OR16.627,95％ CI4.691～58.934;P =0.000)이급장기복용CCB( OR 4.147,95％ CI1.053～16.332；P=0.042)、ACEI/ARB( OR 4.841,95％ CI 1.539～15.231;P=0.007)위CR적독립위험인소.결론 결혈성졸중환자적CR여다충인소유관,기중당뇨병、총담고순증고이급장기복용 CCB화ACEI/ARB시CR적독립위험인소.
Objective To investigate the risk factors for clopidogrel resistance (CR) in patients with ischemic stroke.Methods Turbidimatry was used to measure the platelet aggregation rate changes after the patients with acute ischemic stroke taking 75 mg of clopidogrel per day for 10-14 days.The patients were divided into either a CR or a clopidogrel sensitivity (CS) group according to the platelet aggregation rate changes.The demographic and clinical data of both groups were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for CR.Results A total of 147 patients with acute ischemic stroke were included,42 of them (28.57％ ) were in the RC group and 105 (71.43％) were in the CS group.The proportion of patients in diabetes (54.76％ vs.11.43％ ;x2 =31.054,P =0.000),the history of transient ischemic attack (TIA) (80.95％ vs.26.67％ ;x2 =36.251,P=0.000) or percutaneous coronary intervention (PCI) (26.19％ vs.3.81％;x2 =16.400,P=0.000),taking calcium channel blocker (CCB) (83.33％ vs.54.29％ ;x2 =10.810,P =0.001 ),angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) (66.67％ vs.42.86％;x2 =6.803,P=0.009),and proton pump inhibitor (47.62％ vs. 14.29％;x2 =18.375,P =0.000) in the CR group,as well as the levels of plasma total cholesterol (TC),glucose,and glycated hemoglobin were significantly higher than those in the CS group.Multivariate logistic regression analysis showed that diabetes (odds ratio [ OR] 13.711,95％ confidence interval [ CI] 1.667 - 112.784; P =0.015),increased TC level (OR 2.828,95％CI 1.574 - 5.080; P =0.001),previous history of TIA (OR16.627,95％ CI 4.691 - 58.934; P =0.000),and long-term taking CCB (OR 4.147,95％ CI 1.053 - 16.332;P =0.042),and ACEI/ARB (OR 4.841,95％ CI 1.539 - 15.231; P =0.007) were the independent risk factors for CR.Conclusions CR in patients with ischemic stroke is associated with a variety of factors,in which diabetes,increased TC,as well as long-term taking CCB and ACEI/ARB are the independent risk factors for CR.
