阿司匹林抵抗与脑梗死严重程度及脑梗死面积大小的关系分析  

Association of aspirin resistance with stroke severity and infarct size in ischemic stroke patients

作　　者：徐从英[1] 沈宇斐 王琰萍[1] 张晓玲[1] 翟丽萍[1] 官俏兵[1] XU Congying;SHEN Yufei;WANG Yanping(Department of Neurology,the Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]嘉兴学院附属第二医院神经内科,314000

出　　处：《浙江医学》2018年第20期2264-2267,共4页Zhejiang Medical Journal

基　　金：嘉兴市产业共性关键技术研究项目(2015AY23021)

摘　　要：目的探讨阿司匹林抵抗(AR)的危险因素,分析AR与脑梗死严重程度及梗死面积大小的关系。方法选择150例诊断明确的脑梗死患者,本次脑梗死发作前均服用阿司匹林100mg每晚1次,至少1周,入院后每晚继续口服100mg阿司匹林。入院12h内检测血小板聚集率,筛选出AR患者及阿司匹林敏感(AS)患者,通过美国国立卫生研究院脑梗死量表(NIHSS)评分评估脑梗死临床严重程度,通过基于弥散加权成像的Al Berta脑梗死早期CT评分(DWI-ASPECTS)评估急性脑梗死面积大小。采用logistic回归分析AR的危险因素。结果 150例脑梗死患者中AR患者39例(26.0%),AS患者111例(74.0%)。AR组糖尿病患者比例及血LDL-C水平均高于AS组;糖尿病、高LDL-C血症为AR发生的独立危险因素(OR=3.098、5.501,95%CI:1.053～9.114、2.739～11.049,均P<0.01)。AR组NIHSS评分为(11.54±4.48)分,高于AS组的(10.07±4.25)分(t=2.03,P<0.05),AR组患者较AS组患者更容易发生严重的脑梗死。AR组DWI-ASPECTS评分为(7.86±1.31)分,低于AS组的(8.45±1.55)分(t=2.34,P=0.02),AR组患者亦更容易发生大面积脑梗死。结论 AR可使急性脑梗死患者的梗死严重程度和脑梗死面积明显增加。Objective To investigate the association between aspirin resistance and stroke severity in acute strokepatients. Methods One hundred and fifty patients with acute cerebral infarction who receiving aspirin therapy prior to strokeonset were enrolled in the study. The aspirin resistance test was performed in all patients after admission. Clinical strokeseverity was assessed with the National Institutes of Health Stroke Scale （NIHSS） and infarct size was measured with theAlBerta stroke program early CT score on diffusion weighted imaging （DWI-ASPECTS）. Logistic regression was used toestimate the risk factors of aspirin resistance. Results Among 150 patients, 39（26.0%） were resistant to aspirin （AR group） and111（74.0%） patients were sensitive to aspirin （AS group）.The proportion of diabetic patients and the level of low densitylipoproteins （LDL-C） in AR group were higher than those in AS group.Diabetes（OR=3.098, 95%CI 1.053～9.114, P=0.001）andhigh LDL level （OR=5.501, 95%CI： 2.739～11.049, P=0.000） were independent risk factors of aspirin resistance. The NIHSSscores in AR group were higher than those in AS group （11.54±4.48 vs. 10.07±4.25, t=2.03, P〈0.05）. The DWI-ASPECTSscores in AR group were lower than those in AS group （7.86±1.31 vs. 8.45±1.55, t=2.34, P =0.02）. Conclusion Aspirin resistanceis associated with increased clinical severity and cerebral infarct volume in acute stroke patients.

关 键 词：脑梗死 阿司匹林抵抗 危险因素 美国国立卫生研究院脑梗死量表评分 AlBerta脑梗死早期CT评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]