VerifyNow-Aspirin评估阿司匹林抗血小板效应及其影响因素分析  

Assessment of the Antiplatelet effects of Aspirin and Influencing Factors Analysis with VerifyNow-Aspirin System

作　　者：崔翰斌[1] 林少沂[1] 陈晓敏[1] 王胜煌[1] 朱绥 董亚 陈悦能 蔡文云 杜卫平[1] 周宏林 李佳[1] 高文辉[1] 李晓静[1] 

机构地区：[1]浙江省宁波市第一医院心脏中心,315010 [2]浙江省宁波市姜山镇社区卫生服务中心,315010

出　　处：《心脑血管病防治》2012年第3期189-192,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：卫生部科学研究基金-浙江省医药卫生重大科技计划基金(WKJ2009-2-034)

摘　　要：目的联合VerifyNow-Aspirin与尿11-脱氢-血栓烷B2测定,评估阿司匹林抗血小板效应及其影响因素。方法选择规律服用阿司匹林至少两周的冠心病患者264例,年龄33～86(65.31±10.23)岁,其中男147例(55.7%),女117例(44.3%)。阿司匹林标准剂量组(100mg/d)241例,低剂量组(25～75mg/d)23例。采用VerifyNow-aspirin系统测定服用阿司匹林后血小板残余活性(用ARU表示),酶联免疫吸附法检测尿11-脱氢-血栓烷B2(11-DH-TXB2)浓度,并记录入选人群的基线资料及心血管疾病危险因素。结果以ARU≥550为切割值定义阿司匹林低反应性(ALR)人群,标准剂量组人群中ALR发生率为8.6%(23例)。ALR人群尿11-DH-TXB2显著高于正常反应组,差异有统计学意义(2.85±0.73pg/ml vs 2.51±0.49pg/ml,P<0.05),但二者之间相关性较差(r=0.18,P=0.04)。女性、高血压及糖尿病均为ARU升高的预测因素(均P<0.05),但其组间尿11-DH-TXB2水平差异无统计学意义(均P>0.05)。与阿司匹林标准剂量组比较,低剂量组人群残余血小板活性显著增强,同时伴有尿11-DH-TXB2升高(均P<0.05)。结论阿司匹林抗血小板效应存在个体差异,且具有一定量效关系,而VerifyNow和尿11-DH-TXB2对评估阿司匹林抗血小板效应及其发生机制具有一定互补性。Objective To evaluate the platelet effectiveness of aspirin by combination of VerifyNow-aspirin assay and urinary 11-dehydro-thromboxane B2（11-DHTXB2） level,and investigate the factors that affect the platelet responsiveness.Methods A total of 264 cases with aspirin treatment for primary or secondary prevention for coronary artery disease were recruited,aged 33 to 86（mean 65.31±10.23） years,including 147male（55.7%） and 117 female（44.3%）.Study population consisted of 241 cases receiving standard dose of aspirin（100mg/d） and 23 cases with low dose of aspirin（25～75mg/d）.VerifyNow-Aspirin assay was employed to evaluate the residual platelet activity expressed as ARU,which was compared with urinary 11-DH-TXB2 level.Baseline characteristics including cardiovascular risk factors were recorded in detail.Results Aspirin resistance（AR） was defined as ARU value equal or more than 550,and it occurred in 23 of 241 cases（8.6%）.Urinary 11-DH-TXB2 levels（log transformation） level were significantly higher in AR group than controls（2.85±0.73 pg/ml Vs.2.51±0.49 pg/ml,P〈0.05）,while linear correlation relationship was weak,but significant（r=0.18,P=0.04）.Female and presences of hypertension and diabetes were significantly associated with ARU value（P〈0.05）,but there was no significant between urinary 11-DH-TXB2 levels.Compared with group receiving standard dose of aspirin（100mg/d）,individuals with low aspirin（25～75mg/d） showed higher ARU（484.96±55.22 Vs.458.99±51.14,P〈0.05） and urinary 11-DH-TXB2 levels（6.49±0.85pg/ml Vs.5.70±1.21pg/ml,P〈0.05）.Conclusions Our study shows individual differences of platelet’s response to aspirin,and dose-dependent relationship of aspirin on platelet aggregation,which is domenstrated by VerifyNow-Aspirin assay and urinary 11-DH-TXB2 levels measurements.

关 键 词：阿司匹林 血小板残余活性 VerifyNow 尿11-脱氢-血栓烷B2 

分 类 号：R541.4[医药卫生—心血管疾病]