缺血性脑卒中患者阿司匹林抵抗的危险因素调查

发布时间：2018-01-24 04:54

本文关键词： 缺血性脑卒中阿司匹林抵抗危险因素　出处：《东南大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景缺血性脑卒中,是指因脑部血液循环障碍,缺血或缺氧所致的局限性脑组织的缺血性坏死或软化。大量循证医学证据表明,阿司匹林在缺血性脑血管病的预防中具有重要价值,可显著减少各类栓塞及血栓形成事件的发生率。阿司匹林主要通过脂肪酸环氧酶-1(COX-1)活性部位的529位丝氨酸被不可逆地乙酰化,阻止花生四烯酸(AA)结合其乙酰化位点,抑制血栓素A2(TXA2)的合成,从而发挥抗血小板聚集作用。但是,我们在临床实践中观察到并非所有服用阿司匹林者均能获得良好的临床效果,在进行阿司匹林治疗的心脑血管疾病患者中,仍有血栓形成或栓塞事件发生,称之为临床阿司匹林抵抗。同时很多实验室检查研究也发现接受阿司匹林治疗的患者的血小板活性不能被充分抑制,称之为实验室阿司匹林抵抗。有研究表明实验室阿司匹林抵抗与临床阿司匹林抵抗相关。阿司匹林抵抗的检出率波动很大并且依赖于制定此条件的标准。在Z-HXu等人采用光透射聚集仪(LTA)、血小板功能分析仪(PFA)、血栓弹力图(TEG)、11-去氢-血栓烷B2含量及P选择素测定来评估阿司匹林对血小板作用的研究中,将公认的判定血小板活化状态的“金标准”一P选择素阳性的血小板用作基线标准,血栓弹力图一花生四烯酸(TEG-AA)血小板图实验有更高的敏感性、特异性以及和P选择素测定的一致性,且操作简便、重复性好,更有助于制定个体化的抗血小板治疗方案。本研究采用TEG-AA血小板图实验来检测患者是否对阿司匹林抵抗,通过调查缺血性脑卒中患者阿司匹林抵抗的危险因素,以期为脑血管病的临床防治提供依据。目的调查缺血性脑卒中患者阿司匹林抵抗的相关危险因素。方法2013年11月至2015年03月入住东南大学附属中大医院神经内科患者中,入选经头颅核磁共振(MRI)平扫或电子计算机断层扫描(CT)平扫证实存在缺血性脑卒中且均行TEG-AA实验室检查的患者163例。录入入组患者人口学资料、基础疾病、血液学指标、TEG-AA抑制率值。TEG-AA抑制率20%为阿司匹林抵抗,20%≤TEG-AA抑制率≤50%为阿司匹林半抵抗,TEG-AA抑制率50%为阿司匹林敏感,阿司匹林抵抗及半抵抗合称为阿司匹林非敏感。进行相关性分析,总结出入组缺血性脑卒中患者阿司匹林抵抗的危险因素。结果研究期间共纳入163例患者,其中阿司匹林敏感组132例,阿司匹林非敏感组31例,包括阿司匹林抵抗组15例,阿司匹林半抵抗组16例。在阿司匹林敏感组与非敏感组对比中,采用独立样本t检验对定量指标的分布进行差异检验、卡方检验对定性指标的分布进行差异检验,显示仅是否患有冠心病一项指标在两组对比中p0.05,说明是否患有冠心病在两组间存在统计学意义,回归分析显示患有冠心病的回归系数为0.987,为正,冠心病对阿司匹林半抵抗相对危险度为0.373(0.163,10.852),说明患有冠心病的患者阿司匹林非敏感的可能性高。在阿司匹林敏感组与抵抗组对比中,采用独立样本t检验对定量指标的分布进行差异检验、卡方检验对定性指标的分布进行差异检验,显示空腹血糖(FBG)、糖化血红蛋白(HbA1c)指标在两组对比中p0.05,说明空腹血糖、糖化血红蛋白在两组间存在统计学意义,回归方程分析显示空腹血糖、糖化血红蛋白两项指标p值均大于0.05未能进入回归方程,说明糖化血红蛋白、空腹血糖对阿司匹林抵抗无显著性。在阿司匹林敏感组与半抵抗组对比中,采用独立样本t检验对定量指标的分布进行差异检验、卡方检验对定性指标的分布进行差异检验,显示仅是否患有冠心病一项指标在两组对比中p0.05,说明是否患有冠心病在两组间存在统计学意义,回归分析显示患有冠心病的回归系数为1.552,为正,冠心病对阿司匹林半抵抗相对危险度为4.720(1.553,14.352),说明患有冠心病的患者阿司匹林半抵抗的可能性高。在阿司匹林抵抗组与半抵抗组对比中,采用独立样本t检验对定量指标的分布进行差异检验、卡方检验对定性指标的分布进行差异检验,显示糖化血红蛋白在两组对比中p0.05,说明糖化血红蛋白在两组间存在统计学意义,回归分析显示糖化血红蛋白回归系数为0.925,为正,糖化血红蛋白对阿司匹抵抗相对危险度为2.523(1.188,5.357),说明糖化血红蛋白值越高的患者阿司匹林抵抗的可能性越高。结论本研究结果提示一定数量的缺血性脑卒中患者在服用阿司匹林时未能达到理想的抗血小板聚集作用。本研究提示患有冠心病和高糖化血红蛋白为阿司匹林抵抗的危险因素。
[Abstract]:Background ischemic stroke, is due to the disturbance of blood circulation, local brain tissue caused by hypoxia ischemia or necrosis or softening. A large number of evidence-based medical evidence that aspirin has important value in the prevention of ischemic cerebrovascular disease, can significantly reduce the incidence of thrombosis and embolism. Aspirin the fatty acid cyclooxygenase -1 (COX-1) 529 serine active site was not reversible acetylation, stop four arachidonic acid (AA) combined with its acetylation sites, inhibition of thromboxane A2 (TXA2) synthesis from play a role in platelet aggregation. However, we have observed in clinical practice not all aspirin the patients could obtain good clinical effect in the treatment of aspirin, cardiovascular and cerebrovascular disease patients, there is still the event of thrombosis or embolism, called clinical aspirin against At the same time. Many anti laboratory studies have found that platelet activity cannot accept asplineaspirin is sufficiently suppressed, known as aspirin resistance. Laboratory studies show that laboratory aspirin resistance associated with aspirin resistance. Clinical aspirin resistance detection rate fluctuates greatly and depends on the development of this condition. The standard light transmission aggregometer in Z-HXu et al (LTA), platelet function analyzer (PFA), Thrombelastogram (TEG, 11-) to the hydrogen content of B2 and P were selected to evaluate the determination of thromboxane on platelet function in aspirin, determination of platelet activation will be recognized as the "gold standard" P were used as the baseline platelet selection standard Thrombelastogram, a four arachidonic acid (TEG-AA) platelet diagram experiment has higher sensitivity, specificity and consistency of P selectin and determination, and the operation is convenient. As a simple, reproducible, more conducive to the development of individualized antiplatelet therapy. This study used TEG-AA platelet mapping experiments to test whether patients on aspirin resistance, through the investigation of aspirin resistance in patients with ischemic cerebral stroke risk factors, provide the basis for clinical prevention and treatment for cerebral vascular disease. Objective to investigate the risk of aspirin resistance in patients with ischemic stroke. Methods from November 2013 to 2015 03 months in the neurology department of Zhongda Hospital Affiliated to Southeast University were selected, the head magnetic resonance imaging (MRI) scan or computed tomography (CT) scan confirmed the existence of 163 cases of patients with ischemic stroke and TEG-AA were performed in laboratory examination. Entry into the group of patients with basic demographic data, the disease, hematological indexes, TEG-AA inhibition rate value.TEG-AA inhibition rate of 20% for aspirin resistance, 20% TEG-AA inhibition rate is less than 50 % for aspirin resistance, the inhibition rate of TEG-AA 50% for aspirin sensitive, aspirin resistance and resistance are called non aspirin sensitive. Through correlation analysis, summed up the entry group of aspirin resistance in patients with ischemic cerebral stroke risk factors. Results during the study period, a total of 163 patients were enrolled, including aspirin sensitive group 132 cases, 31 cases of non aspirin sensitive group in 15 cases, including aspirin resistance group, aspirin resistance group 16 patients in the aspirin sensitive group and non sensitive group comparison, independent samples t tests were used to test the difference of distribution of quantitative indicators, differences in testing the chi square test of qualitative index distribution, only an indicator of whether P0.05 patients suffering from coronary heart disease in two groups in contrast, whether suffering from coronary heart disease had statistical significance between the two groups, regression analysis showed that the regression coefficient was 0.987 for patients suffering from coronary heart disease. The relative risk of coronary heart disease, aspirin resistance was 0.373 (0.163,10.852), that suffers from coronary heart disease patients in aspirin sensitive non high possibility. In aspirin sensitive group and resistant group comparison, independent samples t tests were used to test the difference of distribution of quantitative indicators, differences in testing the chi square test of qualitative index distribution. According to the fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c) index in the two group comparison that P0.05, fasting blood glucose, glycosylated hemoglobin had statistical significance between the two groups in the regression equation analysis show the fasting blood glucose, glycosylated hemoglobin two index p values are greater than 0.05 that failed to enter the regression equation, HbA1c, fasting blood glucose aspirin resistance was not significant. In aspirin sensitive group and resistant group comparison, independent samples t test was used to quantitative index distribution difference Different test of difference test chi square test of qualitative index distribution, only an indicator of whether P0.05 patients suffering from coronary heart disease in two groups of contrast, whether suffering from coronary heart disease had statistical significance between the two groups, regression analysis showed that the regression coefficient was 1.552 with coronary heart disease, coronary heart disease is positive, the relative risk of aspirin resistance. 4.720 (1.553,14.352), indicating the possibility of coronary heart disease patients of aspirin resistance is high. In aspirin resistance group and semi resistance group comparison, independent samples t tests were used to test the difference of distribution of quantitative indicators, differences in testing the chi square test of qualitative index distribution, display of glycosylated hemoglobin in two groups of contrast in P0.05 note, glycosylated hemoglobin had statistical significance between the two groups, regression analysis showed that HbA1c regression coefficient was 0.925, positive, glycated haemoglobin Protein on aspirin resistance relative risk was 2.523 (1.188,5.357), indicating the HbA1c value is higher in patients with aspirin resistance probability is higher. Conclusion the results of this study indicated that a certain number of ischemic stroke patients taking aspirin failed to reach the ideal. This study suggests that platelet aggregation with coronary heart disease and HbA1c for risk aspirin resistance factors.

【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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