停用氯吡格雷后血小板功能“反跳”和缺血性脑卒中相关性研究

发布时间：2018-03-15 10:00

本文选题：缺血性脑卒中　切入点：氯吡格雷　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:缺血性脑卒中是各类原因导致脑部血液供给障碍而出现的脑组织缺血坏死。是神经内科最常见的多病因疾病,其预后差,致死和致残率高,给患者家庭和社会带来沉重的负担,是现阶段我国卫生康健事业所面临的最大挑战之一。体内血小板的活化、粘附和聚集与此种疾病的进展密切相关。抗血小板治疗是缺血性脑卒中二级预防中的基本治疗。氯吡格雷是一种吩噻吡啶类抗血小板药物,临床应用安全性高,能显著降低缺血性事件的相对危险性。“血小板功能反跳”是近年来在缺血性心脑血管病患者中断氯吡格雷治疗后发现的。目前尚缺乏一个确切、科学的界定,且没有前瞻性的试验报道抗血小板药物停用后血小板活性反跳与不良局部缺血事件之间存在直接关联。本研究通过PL-11血小板功能监测仪监测血小板功能,分析氯吡格雷与血小板功能反跳的关系,以及血小板功能反跳与再发缺血性脑卒中的相关性,指导临床合理用药。方法:搜集在哈励逊国际和平医院神经内科2014年9月至2015年11月就诊于神经内科服用氯吡格雷的缺血性卒中患者289例。同时开始监测这些患者的血小板功能(ADP二磷酸腺苷、AA花生四烯酸)并随访统计出坚持服药和因各种原因停服氯吡格雷的患者,继续进行血小板功能检测至少2个月,观察血小板聚集“反跳”情况或主要终点事件(缺血性)的发生情况的相关性。采用SPSS19.0统计软件对数据进行χ2分析,检验标准α=0.05,以P0.05表明差异有统计学意义。结果:1、289例患者中,氯吡格雷抵抗者30例(10.4%),这些患者继续随访过程中,发现复发短暂性脑缺血发作TIA或缺血性脑卒中的约8例(26.7%),非氯吡格雷“抵抗”或低反应者259例(89.6%)。因各种原因(经济、出血、健康宣教不到位等)停服氯吡格雷的约153例,停药比率约为52.9%,停药后复发率是26.8%(Table 1)。2、对停服氯吡格雷的患者继续进行为期2个月以上(1周、2周、4周时)的血小板功能检测,血小板聚集力均出现不同程度的增加,ADP-PL-11显示的范围在45%-60%。(Table 2、Fig.2)缺血性脑卒中患者的血小板功能变化增加了卒中复发的风险。3、发现约76例患者出现了血小板聚集功能“反跳”的变化并有33例存在缺血性卒中的再发。血小板反跳和缺血性卒中的复发存在显著相关(P0.05)提示停服氯吡格雷、血小板功能和缺血性卒中之间存在某种相关性。结论:缺血性脑卒中患者停用氯吡格雷后存在血小板功能反跳,血小板功能的变化会增加缺血性脑卒中再发风险的几率。这意味着抗血小板药的合理应用对缺血性卒中的预防仍需引起进一步的关注,对氯吡格雷的合理应用提供重要的临床指导价值。
[Abstract]:Objective: ischemic stroke is a kind of ischemic necrosis of brain tissue caused by various causes of cerebral blood supply disturbance. It is the most common multi-etiological disease in neurology department. Its prognosis is poor, the rate of death and disability is high. Bringing a heavy burden to patients' families and society is one of the biggest challenges facing the health and health of our country at this stage. The activation of platelets in the body. Adhesion and aggregation are closely related to the progress of the disease. Antiplatelet therapy is the basic treatment in secondary prevention of ischemic stroke. Clopidogrel is a phenothiopyridine antiplatelet drug with high safety in clinical application. Platelet function rebound was discovered in recent years after the interruption of clopidogrel treatment in patients with ischemic cardio-cerebrovascular disease. There was no prospective study to report a direct correlation between platelet activity rebound and adverse local ischemic events after antiplatelet drug discontinuation. Platelet function was monitored by PL-11 platelet function monitor. To analyze the relationship between clopidogrel and platelet function rebound, and the correlation between platelet function rebound and recurrent ischemic stroke. Methods: a total of 289 patients with ischemic stroke treated with clopidogrel from September 2014 to November 2015 in the Department of Neurology, Harrison International Peace Hospital, were collected and monitored. Patients with ADP adenosine diphosphate AA arachidonic acid) were followed up with clopidogrel and clopidogrel for various reasons. The platelet function test was carried out for at least 2 months to observe the correlation of platelet aggregation "rebound" or the occurrence of main end point events (Ischemia). The data were analyzed by 蠂 ~ 2 analysis with SPSS19.0 statistical software. Results 30 of 289 patients with clopidogrel resistance had clopidogrel resistance and 30 had clopidogrel resistance. It was found that about 8 patients with recurrent transient ischemic attack (TIA) or ischemic stroke (26. 7%), 259 cases with non clopidogrel "resistance" or low reaction (89. 6%) stopped taking clopidogrel for various reasons (economy, bleeding, lack of health education, etc.). The withdrawal rate was about 52.9, and the recurrence rate after withdrawal was 26.8kytabl1.2.The platelet function of patients who stopped taking clopidogrel for more than two months and two weeks and four weeks continued to be measured. Platelet aggregation increased in varying degrees; ADP-PL-11 showed a range of 45-60) changes in platelet function in patients with ischemic stroke, which increased the risk of stroke recurrence. It was found that about 76 patients had platelet aggregation. " There were 33 cases of recurrent ischemic stroke. There was a significant correlation between platelet rebound and recurrence of ischemic stroke (P0.05) indicating that clopidogrel was stopped. Conclusion: there is a platelet function rebound in patients with ischemic stroke after stopping clopidogrel. Changes in platelet function increase the risk of recurrent ischemic stroke. This means that rational use of antiplatelet drugs for the prevention of ischemic stroke needs further attention. It provides important clinical guidance value for the rational application of clopidogrel.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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