大动脉粥样硬化型脑梗死患者发生阿司匹林抵抗的危险因素分析

目的:探讨大动脉粥样硬化型脑梗死患者阿司匹林抵抗(AR)的临床特征,并分析AR发生的危险因素。方法:依照TOAST分型标准,选择发病7 d内急性大动脉粥样硬化型脑梗死患者160例,统一给予拜阿司匹林(200 mg,1次/日)口服抗血小板聚集治疗;7 d后用血栓弹力图(TEG)检测血小板抑制率,并根据结果将患者分为阿司匹林敏感(AS)组和AR组;比较2组临床资料及生化指标水平,分析AR的危险因素。结果:TEG检测结果显示,AR者42例(26.3%),AS者118例;2组花生四烯酸抑制率分别为(42.6±18.9)%和(76.3±15.8)%(P<0.05)。单因素分析结果显示,AR组吸烟、饮酒、糖尿病史患者比例及血清Hcy、hs-CRP水平显著高于AS组(P<0.05)。Logistic回归分析显示,糖尿病史、吸烟及高Hcy是AR发生的独立危险因素。结论:大动脉粥样硬化型脑梗死患者中存在AR,糖尿病史、吸烟史及高Hcy水平是AR发生的独立危险因素。

Analysis of Risk Factors for Aspirin Resistance in Patients with Large-Artery AtheroscleroticCerebral Infarction

To investigate the clinical characteristics of aspirin resistance (AR) in patients withlarge-artery atherosclerotic cerebral infarction and to analyze the risk factors for AR. Methods: According tothe TOAST classification criteria, 160 patients with acute large-artery atherosclerotic cerebral infarction within 1week of onset were recruited and treated with oral aspirin (200 mg, once a day) for anti-platelet aggregation.Thromboelastography (TEG) was used to detect platelet inhibition rate after 1 week of treatment, and based onthese results, patients were divided into the aspirin sensitive (AS) group and AR group. The clinical data and biochemical indicators of the two groups were compared and analyzed to determine the risk factors of AR. Results:The TEG results showed 42 patients (26.3% ) with AR and 118 patients with AS; the inhibition rates of arachiodonicacid in the two groups were (42.6±18.9)% and (76.3±15.8)% respectively (P<0.05). Univariate analysisshowed that, compared with that of the AS group, the proportion of patients with a history of diabetes, smoking,and drinking and the serum Hcy and hs-CRP levels were significantly higher in the AR group (P<0.05). Logisticmultivariate analysis showed that diabetic history, smoking and high Hcy levels are independent risk factors ofAR. Conclusion: AR may exist in patients with large-artery atherosclerotic cerebral infarction. A history of diabetes and smoking and high Hcy levels are independent risk factors for AR occurrence.