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目的探讨急性脑梗死患者氯吡格雷抵抗(clopidogrel resisitance,CR)的相关因素。方法收集急性脑梗死患者100例,入院后连续口服氯吡格雷7 d后空腹抽取肘静脉血,用血栓弹力图(thromboelastograms,TEG)测得二磷酸腺苷(adenosine diphosphate,ADP)受体途径诱导的血小板抑制率,将患者分为氯吡格雷抵抗组(CR)和氯吡格雷敏感组(clopidogrel sensitivity,CS);根据2组患者的临床检测水平和Logistic回归分析引起CR的因素。结果 31例患者出现氯吡格雷抵抗,发生率为31%。单因素分析发现并发2型糖尿病、LDL-C水平、空腹血糖水平(FPG)差异明显(P<0.05)。多因素Logistic回归分析发现,2型糖尿病(OR=13.198,P<0.05)、LDL-C水平(OR=0.349,P<0.05)是引起CR的独立危险因素。结论部分急性脑梗死患者会出现氯吡格雷抵抗,2型糖尿病、LDL-C水平是其独立危险因素。
Objective To investigate the related factors of clopidogrel resistance (CR) in patients with acute cerebral infarction. Methods 100 cases of patients with acute cerebral infarction were collected. Clopidogrel was given orally for 7 consecutive days and elbow venous blood was collected on an empty stomach. The adenosine diphosphate (ADP) receptor pathway was induced by thromboelastograms (TEG) The patients were divided into clopidogrel resistance group and clopidogrel sensitivity group (CS). The CR factors were analyzed according to the level of clinical examination and Logistic regression in two groups. Results Clopidogrel resistance occurred in 31 patients, with a prevalence of 31%. Univariate analysis found that type 2 diabetes mellitus, LDL-C levels, fasting plasma glucose (FPG) difference was significantly (P <0.05). Multivariate Logistic regression analysis showed that LDL-C level (OR = 0.349, P <0.05) was an independent risk factor for type 2 diabetes (OR = 13.198, P <0.05). Conclusion Some patients with acute cerebral infarction may develop clopidogrel resistance, type 2 diabetes and LDL-C levels are independent risk factors.