阿司匹林抵抗的危险因素分析和临床干预

目的探讨脑梗死患者阿司匹林抵抗的危险因素,研究阿司匹林抵抗者抗血小板药物调整后阿司匹林抵抗的发生情况及预后。方法选取269例新发脑梗死患者,口服阿司匹林100 mg/d,经血栓弹力图筛选出阿司匹林抵抗者90例,分析其危险因素,并将其随机分为3组:A组口服阿司匹林200 mg/d;B组口服阿司匹林100 mg/d+氯吡格雷75 mg/d;C组口服阿司匹林100 mg/d。1 m后复测血栓弹力图,比较血小板抑制率的变化。随访12 m观察血管事件和死亡的发生情况。结果阿司匹林抵抗的发生率为33.5%。单因素分析显示,阿司匹林抵抗组(AR)与阿司匹林敏感组(AS)年龄比较差异有统计学意义(P=0.029);Logistic回归分析显示,年龄是脑梗死患者阿司匹林抵抗的危险因素(OR=1.026,95%CI 1.002 1.049,P=0.030)。A组和B组患者AA诱导的血小板抑制率明显升高(P0.05),且B组患者血小板抑制率升高更明显;C组患者AA诱导的血小板抑制率较前无明显改变(P0.05)。随访12 m后3组患者总体缺血性事件发生率比较差异有统计学意义(P=0.002),C组总体缺血性事件发生率明显高于A组和B组;3组患者出血性事件发生率比较差异无统计学意义(P0.05)。结论年龄是脑梗死患者阿司匹林抵抗的危险因素;阿司匹林加量或联合氯吡格雷治疗可以有效改善阿司匹林抵抗现象,并可减少或避免缺血性事件发生。

The risk factors and clinical intervention of Aspirin resistance

Objective To investigate the risk factors of aspirin resistance in cerebral infarction,and to study the incidence and prognosis of aspirin resistance after adjustment of antiplatelet drugs.Methods A total of 269 cases of cerebral infarction patients,oral aspirin 100 mg/d.Of the 269 patients,a subgroup of subjects with aspirin resistance were selected on the basis of the results of thrombelastogram.Analysis of the risk factors,and aspirin resistance were randomized equally in three groups:Group A oral aspirin 200 mg/d,Group B oral aspirin 100 mg/d+clopidogrel 75 mg/d,Group C oral aspirin 100 mg/d,platelet aggregation tests were repeated after at least one month,then compared the rate of platelet inhibition.Followed up for 12 months to observe the occurrence of vascular events and death.Results The occurrence rate of aspirin resistance was 33.5%.Univariate analysis showed that aspirin resistance group (AR) and aspirin sensitive group (AS) was statistically significant age difference (P=0.029).Logistic regression analysis showed that age was the risk factor of aspirin resistance in patients with cerebral infarction (OR=1.026,95%CI 1.002~1.049,P=0.030).In group A and group B,platelet inhibition rate of AA was significantly higher (P<0.05),and platelet inhibition rate of B group was more obvious.The inhibition rate of AA induced platelet inhibition in group C was no significant change (P>0.05).After 12 months of follow-up,the difference of the overall ischemic events in three groups was statistically significant (P=0.002),and the overall rate of ischemic events in group C was significantly higher than the other two groups;there was no significant difference in the incidence of hemorrhagic events between the three groups (P>0.05).Conclusion Age is a risk factor for aspirin resistance;increased aspirin dose or aspirin plus clopidogrel can effectively improve aspirin resistance,and can reduce or avoid the occurrence of ischemic events.