血小板高反应性、坚果消费状况与大动脉粥样硬化性脑梗死复发的相关性研究

doi:10.3969/j.issn.1673-5765.2019.10.007

摘要/Abstract

摘要：

目的探讨血小板高反应性、坚果消费状况与大动脉粥样硬化性脑梗死复发的相关性。方法采用前瞻性队列研究，连续收集2016年10月-2018年10月在西安交通大学第二附属医院神经内科住院治疗的大动脉粥样硬化性脑梗死患者的临床资料，包括患者的一般资料、对阿司匹林/氯吡格雷治疗反应性和坚果消费情况。所有患者共随访6个月，根据缺血性卒中是否复发将患者分为复发组和对照组。通过多因素Logistic回归分析探讨血小板高反应性、坚果消费情况与缺血性卒中复发的关系。结果最终共纳入214例患者进行分析，其中缺血性卒中复发组36例（16.8%），对照组178例（83.2%）。复发组糖尿病患病率、入院时基线LDL-C水平高于对照组，差异有统计学意义。复发组坚果消费率为11.1%（4/36），低于对照组21.3%（38/178），但差异无统计学意义；复发组人群坚果摄入量（P90）为6.6 g/d，坚果消费者的坚果摄入量（P50）为9.0 g/d，均较对照组偏低，但差异均无统计学意义。复发组阿司匹林抵抗及氯吡格雷抵抗的检出率较对照组高（27.8% vs 17.4%；55.6% vs 31.5%），但只有氯吡格雷抵抗在两组间差异有统计学意义（P =0.006）。Logi sti c回归分析显示，氯吡格雷抵抗（OR 2.813，95%CI 1.282～6.171，P =0.010）、糖尿病（OR 3.485，95%CI 1.571～7.729， P =0.002）、高LDL-C水平（OR 1.710，95%CI 1.078～2.710，P =0.023）是大动脉粥样硬化性脑梗死复发的独立危险因素。结论氯吡格雷抵抗与大动脉粥样硬化性脑梗死复发有关；复发患者中坚果消费低于无复发患者，但未能证明坚果消费是脑梗死复发的影响因素。

文章导读： 本研究发现氯吡格雷抵抗与大动脉粥样硬化性脑梗死复发有关；卒中复发患者中坚果消费低于无复发患者，但未能证明坚果消费是卒中复发的独立影响因素。

关键词: 脑梗死; 卒中复发; 氯吡格雷抵抗; 坚果消费

Abstract:

Objective To investigate the correlation between high on-treatment platelet reactivity, nut consumption and recurrent ischemic stroke in patients with large artery atherosclerosis cerebral infarction. Methods This was a prospective cohort study. The patients with large artery atherosclerotic cerebral infarction who consecutively admitted to Department of Neurology of the Second Affiliated Hospital of Xi'an Jiao Tong University from October 2016 to October 2018 were enrolled in this study. The collected clinical data included baseline information, response to aspirine / clopidogrel and nut consumption results. All patients were followed up for 6 months. The patients were divided into recurrence group and control group according to whether the patient experienced recurrent ischemic stroke or not. Multivariate logistic regression analysis was conducted to analyze the relationship between high on-treatment platelet reactivity, nut consumption and recurrent ischemic stroke. Results Finally, a total of 214 patients were included, with 36 cases (16.8%) in recurrence group and 178 cases (83.2%) in control group. The rate of diabetes, baseline LDL-C level in recurrence group were higher than that in control group (P <0.05). The nut consumption rate in recurrence group was lower than that in control group, but there was no statistical difference (11.1% vs 21.3%). The nut intake (P90) in recurrence group was 6.6 g/d, and the nut intake (P50) of the nut consumers was 9.0 g/d, both were lower than that in control group, but the differences were not statistically significant. The detection rates of aspirin resistance and clopidogrel resistance in recurrence group were higher than those in control group (27.8% vs 17.4%; 55.6% vs 31.5%), but only clopidogrel resistance was statistically significant (P =0.006). Logistic regression analysis showed that clopidogrel resistance (OR 2.813, 95%CI 1.282-6.171, P =0.010), diabetes (OR 3.485, 95%CI 1.571-7.729, P =0.002) and high LDL-C level (OR 1.710, 95%CI 1.078-2.710, P =0.023) were independent risk factors of recurrent ischemic stroke in patients with large artery atherosclerosis cerebral infarction. Conclusions Clopidogrel resistance was associated with recurrent ischemic stroke in patients with large artery atherosclerotic cerebral infarction. Nut consumption in patients with recurrent ischemic stroke was lower than that in patients without stroke recurrence, while which did not confirm that nut consumption was an independent influence factor for recurrent ischemic stroke.

Key words: Cerebral infarction; Recurrent stroke; Clopidogrel resistance; Nut consumption

姚丽, 张晓冬, 范松华, 孙宏, 展淑琴, 张桂莲. 血小板高反应性、坚果消费状况与大动脉粥样硬化性脑梗死复发的相关性研究[J]. 中国卒中杂志, 2019, 14(10): 998-1003.

YAO Li, ZHANG Xiao-Dong, FAN Song-Hua, SUN Hong, ZHAN Shu-Qin, ZHANG Gui-Lian. Relationship between High On-treatment Platelet Reactivity, Nut Consumption and Recurrent Atherosclerotic Cerebral Infarction[J]. Chinese Journal of Stroke, 2019, 14(10): 998-1003.

参考文献

[1] COULL A J，ROTHWELL P M. Underestimation

of the early risk of recurrent stroke：evidence of the

need for a standard definition[J]. Stroke，2004，35

（8）：1925-1929.

[2] OZA R，RUNDELL K，GARCELLANO

M. Recurrent ischemic stroke：strategies for

prevention[J]. Am Fam Physician，2017，96（7）：

436-440.

[3] 中国卒中学会科学声明专家组. 症状性颅内外动脉

粥样硬化性大动脉狭窄管理规范——中国卒中学会

科学声明[J]. 中国卒中杂志，2017，12（1）：64-71.

[4] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国缺血性脑卒中和短暂性脑缺

血发作二级预防指南2014[J]. 中华神经科杂志，2015，

48（4）：258-273.

[5] KRASOPOULOS G，BRISTER S J，BEATTIE W S，

et al. Aspirin "resistance" and risk of cardiovascular

morbidity：systematic review and meta-analysis[J].

BMJ，2008，336（7637）：195-198.

[6] GEISLER T，LANGER H，WYDYMUS M，et

al. Low response to clopidogrel is associated

with cardiovascular outcome after coronary stent

implantation[J]. Eur Heart J，2006，27（20）：2420-

2425.

[7] 饶子龙，郑华光，王菲，等. 血栓弹力图凝血酶原通

道检测指标在评价急性缺血性脑血管病患者高血小

板反应性以及预测复发缺血事件中的价值[J]. 中国

卒中杂志，2016，11（3）：207-214.

[8] 陈梦萦，展淑琴，车璐，等. 双抗患者缺血性脑卒中

复发与血小板高反应性的相关性研究[J]. 中风与神

经疾病杂志，2019，36（4）：296-299.

[9] 葛中林，于善花，钱明月，等. 血小板高反应性与非小

卒中患者再发缺血事件的相关性研究[J]. 中华老年

心脑血管病杂志，2019，21（4）：399-402.

[10] DE SOUZA R G M，SCHINCAG LIA R M，

PIMENTEL G D，et al. Nuts and human health

outcomes：a systematic review[J/OL]. Nutrients，

2017，9（12）：E1311. https：//doi.org/10.3390/

nu9121311. [11] ROS E. Nuts and CVD[J]. Br J Nutr，2015，113

（Suppl 2）：S111-S120.

[12] VIALE P H. The benefits of nuts for cancer

prevention[J]. J Adv Pract Oncol，2019，10（2）：102-

103.

[13] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

2014[J]. 中华神经科杂志，2015，48（4）：246-257.

[14] 中国营养学会. 食物与健康——科学证据共识[M].

北京：人民卫生出版社，2016：231.

[15] 琚腊红，于冬梅，许晓丽，等. 中国居民2010-2012年

坚果摄入状况及不同年份变化趋势[J]. 中国公共卫

生，2017，33（6）：916-918.

[16] 欧阳一非，王慧君，王志宏，等. 2015年中国十五省

（自治区、直辖市）老年居民坚果摄入状况[J]. 卫生

研究，2019，48（4）：526-530.

[17] SAMBU N，RADHAKRISHNAN A，DENT

H，et al. Personalised antiplatelet therapy in stent

thrombosis：observations from the Clopidogrel

Resistance in Stent Thrombosis（CREST）

registry[J]. Heart，2012，98（9）：706-711.

[18] ESENWA C，GUTIERREZ J. Secondary stroke

prevention：challenges and solutions[J/OL]. Vasc

Health Risk Manag，2015，11：437-450. https：//doi.

org/10.2147/VHRM.S63791.

[19] 李振光，王彤，张金彪，等. 合并糖尿病或胰岛素抵

抗的缺血性卒中患者的抗血小板治疗[J]. 国际脑血

管病杂志，2016，24（10）：930-935.

[20] VARANASI J S，STEINHUBL S R. Antiplatelet

effect of aspirin in patients with cerebrovascular

disease[J/OL]. Stroke，2004，35（6）：e144-e145.

https：//doi.org/10.1161/01.STR.0000126473.

[21] FIOLAKI A，KATSANOS A H，KYRITSIS

A P，et al. High on treatment platelet reactivity

to aspirin and clopidogrel in ischemic stroke：a

systematic review and meta-analysis[J/OL]. J Neurol

Sci，2017，376：112-116. https：//doi.org/10.1016/

j.jns.2017.03.010.

[22] BLANCO MEJIA S，KENDALL C W，

VIGUILIOUK E，et al. Effect of tree nuts on

metabolic syndrome criteria：a systematic review

and meta-analysis of randomised controlled trials[J/

OL]. BMJ Open，2014，4（7）：e004660. http：//

dx.doi.org/10.1136/bmjopen-2013-004660.

[23] AFSHIN A，MICHA R，KHATIBZADEH S，et

al. Consumption of nuts and legumes and risk of

incident ischemic heart disease，stroke，and diabetes：

a systematic review and meta-analysis[J]. Am J Clin

Nutr，2014，100（1）：278-288.

[24] SHAO C，TANG H，ZHAO W，et al. Nut intake

and stroke risk：a dose-response meta-analysis of

prospective cohort studies[J/OL]. Sci Rep，2016，6：

30394. https：//doi.org/10.1038/srep30394.

[25] MICHA R，PENALVO J L，CUDHEA F，et al.

Association between dietary factors and mortality

from heart disease，stroke，and type 2 diabetes in

the United States[J]. JAMA，2017，317（9）：912-924.

[26] 中国营养学会. 中国居民膳食指南（2016）[M]. 北京：

人民卫生出版社，2016：64-253.