老年女性冠心病患者阿司匹林抵抗的现患率和危险因素调查  

Prevalence of aspirin resistance and its risk factors in elderly female coronary heart disease patients

作　　者：李雪[1] 柯瑟章[2] 陈德友[3] 邹晓[4] 高凌根[4] 刘霖[4] 曹剑[4] 范利[4] 

机构地区：[1]解放军总医院南楼放射科,北京100853 [2]福建医科大学附属漳州市医院干部病房 [3]解放军总医院干部诊疗科,北京100853 [4]解放军总医院南楼心内科,北京100853

出　　处：《中华老年心脑血管病杂志》2016年第10期1034-1037,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：军队保健课题(12BJZ39)

摘　　要：目的调查老年女性冠心病患者阿司匹林抵抗现患率和可能的危险因素。方法纳入北京市万寿路社区老年女性冠心病患者192例,口服阿司匹林75~100mg治疗〉1个月。根据光比浊法检测结果分为阿司匹林抵抗组14例,阿司匹林半抵抗组82例,阿司匹林敏感组96例。光比浊法检测0.5mmol/L花生四烯酸和10μmol/L二磷酸腺苷诱导的血小板聚集率。比较各组一般临床资料特征。结果与阿司匹林敏感组比较,阿司匹林抵抗组TG、同型半胱氨酸、空腹血糖、糖尿病及调脂药物比例显著升高,而HDL-C、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体拮抗剂（ARB）比例显著降低（P〈0.05,P〈0.01）;阿司匹林半抵抗组同型半胱氨酸、空腹血糖、糖尿病比例显著升高,而ACEI/ARB比例显著降低（P〈0.01）。高同型半胱氨酸水平是发生阿司匹林抵抗的危险因素（OR=3.748,95%CI：2.062~6.813,P=0.000）;ACEI/ARB（OR=0.091,95%CI：0.010~0.863,P=0.037）和硝酸酯类（OR=0.126,95%CI：0.016~0.976,P=0.047）是发生阿司匹林抵抗的保护因素。结论老年女性冠心病患者合并高同型半胱氨酸水平的阿司匹林抵抗发生率增加。Objective To provide the reference for antiplatelet treatment by investigating the prevalence of aspirin resistance（AR）and its risk factors in elderly female coronary heart disease（CHD）patients.Methods One hundred and ninety-two elderly female CHD patients from Beijing Wanshoulu Community who took 75-100 mg aspirin for more than 1 month were divided into AR group（n=14）,aspirin semi-resistant group（n=82）and aspirin sensitive group（n=96）.Their platelet aggregation induced by 0.5mmol/L AA and 10μmol/L ADP was detected by light turbidimetry.Results The serum levels of TG,homocysteine and fasting blood glucose,the incidence of diabetes mellitus,and the rate of used lipid-reducing drugs were significantly higher whereas the serum HDL-C level and the ACEI/ARB ratio were significantly lower in AR group than in aspirin sensitive group（P〈0.05,P〈0.01）.The serum levels of homocysteine and fasting blood glucose,the incidence of diabetes mellitus were significantly higher whereas the ACEI/ARB ratio was significantly lower in aspirin semi-resistant group than in aspirin sensitive group（P〈0.01）.High serum homocysteine level was a risk factor for aspirin resistance,ACEI/ARB ratio and nitrates were protective factors for AR（OR=3.748,95%CI：2.062-6.813,P=0.000;OR=0.091,95%CI：0.010-0.863,P=0.037;OR=0.126,95%CI：0.016-0.976,P=0.047）.Conclusion AR increases in elderly female CHD patients with a high homocysteine level.

关 键 词：冠心病 阿司匹林 花生四烯酸类 高半胱氨酸 血小板聚集 

分 类 号：R541.4[医药卫生—心血管疾病]