血栓弹力图评价老年心血管病患者阿司匹林抵抗的发生率及危险因素  

Evaluation of prevalence and risk factors for aspirin resistance in elderly patients with cardiovascular diseases by thrombelastograph

作　　者：曹剑[1] 范利[1] 刘霖[1] 胡国梁[1] 胡亦新[1] 李晓利[1] 石海燕[1] 张荣强 苗克 

机构地区：[1]解放军总医院南楼心血管一科,北京100853 [2]海军北京丰台干休所 [3]总装备部北京第二干休所

出　　处：《中华老年心脑血管病杂志》2011年第9期790-793,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家科技部支撑计划课题(2009BAI86B04);"十一五"军队重点保健课题(07BJZ01)

摘　　要：目的评价老年心血管病患者阿司匹林抵抗的发生率及可能的潜在危险因素。方法选择老年心血管病患者454例,分为阿司匹林抵抗组111例,阿司匹林敏感组343例。口服阿司匹林(≥75 mg)>1个月,采用血栓弹力图法进行血小板聚集功能检测。结果与阿司匹林敏感组比较,阿司匹林抵抗组女性患者较多,P选择素、空腹血糖、TG、LDL-C明显增高,服用硝酸酯类药物的比例明显降低,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,空腹血糖(OR=1.211.95%CI:1.047～1.402,P=0.010)、P选择素(OR=1.010,95%CI:1.002～1.01 9,P=0.019),服用硝酸酯类药物(OR=0.524,95%CI:0.309～0.890,P=0.017)与阿司匹林抵抗相关。结论老年心血管病患者阿司匹林抵抗发生率较高,空腹血糖、P选择素为阿司匹林抵抗的危险因素,硝酸酯药物为其保护性因素。Objective To evaluate the prevalence and risk factors for aspirin resistance in elderly patients with cardiovascular disease. Methods 454 patients（age 73.91±8.12 years） with cardiovascular disease receiving daily aspirin therapy（≥75 mg） over one month were recruited. 111 patients were aspirin-resistant detected by thrombelastograph platelet mapping assay. 343 patients were aspirin-sensitive. Results Compared with aspirin-sensitive patients,there were significantly more women and less patients taking nitrate in the aspirin-resistant group （P 〈0. 05）. Aspirin- resistant patients had higher triglyceride, LDL-C, P-selectin, and fasting serum glucose levels （P 〈0.05,P 〈0. 01）. Multivariate logistic regression analysis showed that fasting serum glucose levels （OR = 1. 211,9% CI ： 1. 047-1. 402, P = 0. 010）,P-selectin level （OR = 1. 010, 95% CI：1. 002-1. 019, P =0. 019） ,administration of nitrates （OR = 0. 524,95% CI ： 0. 309- 0. 890, P = 0. 017） were significantly associated with aspirin resistance. Conclusion The prevalence of aspirin resistance in elderly patients with cardiovascular disease was considerably high. Fasting glucose levels and P-selectin levels are risk factors for aspirin resistance and nitrates therapy is a protective factor.

关 键 词：阿司匹林 心血管疾病 血栓弹力描记术 血小板聚集 P选择素 危险因素 

分 类 号：R54[医药卫生—心血管疾病]