脑梗死患者阿司匹林抵抗与复发缺血性血管事件风险  

Correlation of aspirin resistance and recurrent ischemic vascular events in patients with cerebral infarction

作　　者：林志坚[1] 车秀娟 程欣[1] 董晶[2] 谢闻悦[2] 童晓欣[1] 吴军[1] 

机构地区：[1]北京大学深圳医院神经内科,深圳518036 [2]北京大学深圳医院检验科,深圳518036

出　　处：《卒中与神经疾病》2015年第3期148-151,共4页Stroke and Nervous Diseases

基　　金：深圳市科技研发资金项目(编号为JCYJ20120830161804255)

摘　　要：目的探讨急性脑梗死患者阿司匹林抵抗（AR）的发生与复发缺血性血管事件风险的关系。方法选择2013年7月～2014年6月在北京大学深圳医院神经内科住院的急性脑梗死患者110例,其中男64例,女56例;年龄40～82岁,平均年龄（64.7±12.1）岁。患者口服阿司匹林肠溶片7～10 d后采集外周静脉血,运用全血阻抗法测定血小板聚集程度,0.5 mmol/L花生四烯酸诱导的血小板聚集程度大于0欧姆即定义为AR,根据上述标准将患者分为AR及AS（aspirin sensitive,AS）组,对患者进行为期6个月的随访,终点事件包括短暂性脑缺血发作（TIA）、脑梗死、心肌梗死、死亡。结果 110例患者中31例患者为AR,AR的发生率为28.2%;AR组2型糖尿病患者的比例大于AS组（P〈0.05）;AR组复发缺血性血管事件的发生率大于AS组（22.6%vs 7.9%,P〈0.05）。多元Logistic回归分析显示,AR是急性脑梗死患者缺血性血管事件复发的独立危险因素（OR=4.091,95%CI=0.024～0.946,P〈0.05）。结论脑梗死患者存在一定比例的AR;2型糖尿病可能是AR发生的危险因素;AR可增加急性脑梗死患者复发缺血性血管事件的风险。Objective To explore the correlation of aspirin resistance （AR） and recurrent vascular e- vents in patients with acute cerebral infarction. Methods One-hundred and ten patients （mean age 64. 7±12. 1, 64 male and 56 female） with acute cerebral infarction were consecutively selected who were admitted to the department of neurology in Peking University Shenzhen hospital. Aspirin was administrated regularly to every patient from the first day of admission. Whole blood samples were collected for platelet aggregation tes- ting after aspirin had been administered for 7～10 days. AR was detected by whole blood electrical impedance aggregometry （WBA）. The impedance induced by 0. 5 mmol/1 arachidonic acid（AA）〉0 Ω was identified as AR. The patients were divided into AR group and AS group according to their platelet aggregation. A follow- up period of 6 months was performed to record vascular events, including cerebral infarction, transit ischemic attack （TIA）, myocardial infarction and death. Results AR was detected in 31 patients and the prevalence of AR was 28. 2%. The proportion of type 2 diabetes mellitus in AR group was higher than that in AS group （P 〈0. 05）. Recurrence rate of ischemic vascular events in AR group was higher than that in AS group （22. 6% vs 7. 9% ,P〈0. 05）. Multiple logistic regression analysis found that AR was an independent risk factors for re- current ischemic vascular events in patients with acute cerebral infarction （OR = 4. 091,95% CI = 0. 024 0. 946,P〈0. 05）. Conclusions Aspirin resistance is not uncommon in patients with ischemic stroke taking as- pirin. Type 2 diabetes mellitus is one of the risk factors for aspirin resistance. Patients who are detected to be AR are at a greater risk of recurrent ischemic vascular events.

关 键 词：阿司匹林抵抗 脑梗死 血小板聚集 血小板功能检测 

分 类 号：R743[医药卫生—神经病学与精神病学]