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目的:探讨急性脑梗死患者氯吡格雷抵抗的相关因素。方法:对2014年7月至2016年12月期间在贵州航天医院神经内科住院的脑梗死患者137例予以氯吡格雷。比较氯吡格雷抵抗与敏感者的年龄、性别、吸烟、高血压、糖尿病、同型半胱氨酸和基因型等指标。结果:137例患者中有4例患者对氯吡格雷全抵抗,血小板聚集抑制率<10%,有29例患者对氯吡格雷半抵抗。104例患者对氯吡格雷敏感,所占比例为75.91%。患者的年龄、饮酒、吸烟、高血压、糖尿病、高血脂症、缺血性心脏病、心梗死和同型半胱氨酸,这9个指标与患者是否存在氯吡格雷抵抗无相关性(P>0.05)。基因检测结果可见野生型(GG)、突变杂合型(GA)、突变纯合型(AA)三型。GG型血小板抑制率为(43.4±2.3)%,GA和AA型血小板抑制率为(30.4±2.2)%,GA和AA型血小板抑制率显著低于GG型,差异有统计学意义(P<0.05)。结论:氯吡格雷抵抗与饮酒、吸烟、高血压、糖尿病、高血脂症、缺血性心脏病等因素无关,与患者的基因多态性有关,临床应加强其检测,从而为更为有效的治疗患者疾病。
Objective: To investigate the related factors of clopidogrel resistance in patients with acute cerebral infarction. Methods: 137 patients with cerebral infarction hospitalized in Department of Neurology, Guizhou Aerospace Hospital from July 2014 to December 2016 were treated with clopidogrel. Comparison of clopidogrel resistance and susceptibility of the age, gender, smoking, hypertension, diabetes, homocysteine and genotypes and other indicators. Results: Four of the 137 patients were fully resistant to clopidogrel and the inhibition of platelet aggregation was <10%. Nineteen patients had half-resistance to clopidogrel. 104 patients were sensitive to clopidogrel, accounting for 75.91%. Patients’ age, drinking, smoking, hypertension, diabetes, hyperlipemia, ischemic heart disease, myocardial infarction and homocysteine had no correlation with the presence or absence of clopidogrel resistance (P> 0.05). Gene test results can be seen wild type (GG), mutant heterozygous (GA), mutant homozygous (AA) three types. The inhibition rate of GG platelets was (43.4 ± 2.3)%, that of GA and AA platelets was (30.4 ± 2.2)%, and the inhibition rates of GA and AA platelets were significantly lower than those of GG, the difference was statistically significant (P <0.05 ). Conclusion: Clopidogrel resistance has nothing to do with alcohol, smoking, hypertension, diabetes, hyperlipidemia, ischemic heart disease and other factors, and patients with genetic polymorphisms, clinical testing should be strengthened to be more effective Treatment of patients with diseases.