急性脑梗死患者发生阿司匹林抵抗的危险因素  

Risk factors for aspirin resistance in patients with acute cerebral infarction

作　　者：张仕娟[1] 宋玉宁 李乃坤[1] 孙锡波[1] 李炳选[1] 

机构地区：[1]潍坊医学院附属益都中心医院,山东青州262500

出　　处：《山东医药》2016年第15期62-64,共3页Shandong Medical Journal

基　　金：潍坊市科技局科研课题资助项目(2015ws109)

摘　　要：目的：探讨急性脑梗死患者发生阿司匹林抵抗（ AR）的危险因素。方法162例急性脑梗死患者于入院当日开始口服阿司匹林肠溶片100 mg/d,服用阿司匹林10 d后,根据血小板聚集实验结果将患者分为阿司匹林抵抗（ AR）者（ AR组,49例）和非AR者（非AR组,113例）,收集患者一般临床资料,采用实时荧光定量PCR检测血小板中微小RNA-19a（miR-19a）,利用多因素Logistic回归分析法分析影响AR发生的影响因素,利用受试者工作特征曲线（ROC曲线）评估血小板miR-19a表达量预测AR的价值。结果 AR组血小板miR-19a表达量为0.78±0.09、2型糖尿病26例（53.1%）,非AR组血小板miR-19a表达量为0.59±0.11、2型糖尿病34例（30.1%）,两组比较,P均＜0.05。多因素Logistic回归分析显示,血小板miR-19a表达量升高是影响急性脑梗死患者发生AR的独立危险因素（OR=4.82,95%CI：1.374~15.835）。 ROC曲线分析显示,当miR-19a截断值为0.69时,ROC曲线下面积为0.927（95%CI：0.888~0.966）,诊断急性脑梗死的灵敏度为93.9%、特异度为82.3%。结论急性脑梗死AR患者血小板miR-19a表达升高,是AR发生的独立危险因素,可作为预测急性脑梗死发生AR的指标。Objective To investigate the risk factors for aspirin resistance （ AR） in patients with acute cerebral in-farction. Methods Totally 162 cases of patients with acute cerebral infarction received aspirin enteric-coated tablets 100 mg/d at the beginning of the day of admission. After taking aspirin 10 d, all patients were divided into the AR group （49 cases） and non-AR group （113 cases） according to the results of platelet aggregation test. The clinical data of patients were collected. The expression of microRNA-19a （miR-19a） in the platelets was detected by real-time fluorescence quanti-tative PCR. The influencing factors for the occurrence of AR were analyzed by Logistic regression analysis. The predictive value of expression of miR-19a in platelet for AR was analyzed by using receiver operating characteristic curve （ ROC curve）. Results The expression level of miR-19a in the AR group was 0. 78 ± 0. 09, the type 2 diabetes were found in 26 cases （53. 1%）, while in the non-AR group, the expression level of miR-19a was 0. 59 ± 0. 11, the type 2 diabetes were found in 34 cases （30. 1%）, and significant difference was found between the two groups, all P〈0. 05. Multivariate Lo-gistic regression analysis showed that the increased expression of miR-19a in platelet was an independent risk factor for AR in patients with acute cerebral infarction （OR=4. 82, 95% CI：1. 374-15. 835）. ROC curve analysis showed that, when miR-19a cutoff value was 0. 69, the area under the ROC curve was 0. 927 （95% CI：0. 888-0. 966）, the sensitivity was 93. 9% and the specificity was 82. 3%. Conclusion The expression of miR-19a in platelet of AR in patients with acute cerebral infarction is increased, which is an independent risk factor for the occurrence of AR and may be used as an indica-tor to predict the occurrence of AR in acute cerebral infarction.

关 键 词：急性脑梗死 阿司匹林抵抗 微小RNA-19a 

分 类 号：R741.02[医药卫生—神经病学与精神病学]