阿司匹林抵抗的危险因素分析和临床干预

发布时间：2018-05-17 23:10

本文选题：脑梗死 + 阿司匹林　；参考：《中风与神经疾病杂志》2017年06期

【摘要】：目的探讨脑梗死患者阿司匹林抵抗的危险因素,研究阿司匹林抵抗者抗血小板药物调整后阿司匹林抵抗的发生情况及预后。方法选取269例新发脑梗死患者,口服阿司匹林100 mg/d,经血栓弹力图筛选出阿司匹林抵抗者90例,分析其危险因素,并将其随机分为3组:A组口服阿司匹林200 mg/d;B组口服阿司匹林100 mg/d+氯吡格雷75 mg/d;C组口服阿司匹林100 mg/d。1 m后复测血栓弹力图,比较血小板抑制率的变化。随访12 m观察血管事件和死亡的发生情况。结果阿司匹林抵抗的发生率为33.5%。单因素分析显示,阿司匹林抵抗组(AR)与阿司匹林敏感组(AS)年龄比较差异有统计学意义(P=0.029);Logistic回归分析显示,年龄是脑梗死患者阿司匹林抵抗的危险因素(OR=1.026,95%CI 1.002 1.049,P=0.030)。A组和B组患者AA诱导的血小板抑制率明显升高(P0.05),且B组患者血小板抑制率升高更明显;C组患者AA诱导的血小板抑制率较前无明显改变(P0.05)。随访12 m后3组患者总体缺血性事件发生率比较差异有统计学意义(P=0.002),C组总体缺血性事件发生率明显高于A组和B组;3组患者出血性事件发生率比较差异无统计学意义(P0.05)。结论年龄是脑梗死患者阿司匹林抵抗的危险因素;阿司匹林加量或联合氯吡格雷治疗可以有效改善阿司匹林抵抗现象,并可减少或避免缺血性事件发生。
[Abstract]:Objective to investigate the risk factors of aspirin resistance in patients with cerebral infarction, and to study the occurrence and prognosis of aspirin resistance after antiplatelet drug adjustment in patients with cerebral infarction. Methods A total of 269 patients with newly diagnosed cerebral infarction were treated with aspirin 100 mg / d. 90 patients with aspirin resistance were screened by thromboelastography and their risk factors were analyzed. Three groups were randomly divided into three groups: group A (group A) took aspirin 200mg / d group B group (group B) orally administered aspirin 100 mg/d clopidogrel 75 mg / d group (group C) after oral administration of aspirin 100mg / d group, the thromboelastogram was measured again after oral administration, and the change of platelet inhibition rate was compared. Vascular events and death were observed at a follow-up of 12 m. Results the incidence of aspirin resistance was 33.5. Univariate analysis showed that there was a significant difference in age between aspirin resistance group (ARA) and aspirin sensitive group (ASA). Logistic regression analysis showed that Aspirin resistance group was significantly different from aspirin sensitive group in age (P < 0. 029). Age is the risk factor of aspirin resistance in patients with cerebral infarction. The inhibition rate of platelet induced by AA in group A and group B is significantly higher than that in group A and group B, and the increase of platelet inhibition rate in group B is more obvious than that in group C. The inhibition rate was not significantly changed compared with the former. The incidence of total ischemic events in group C was significantly higher than that in group A and group B after 12 m follow-up. There was no significant difference in the incidence of hemorrhagic events between group A and group B (P 0.05). Conclusion Age is a risk factor for aspirin resistance in patients with cerebral infarction and aspirin dosage or clopidogrel therapy can effectively improve aspirin resistance and reduce or avoid ischemic events.
【作者单位】：青岛大学附属医院神经内科;
【分类号】：R743.33

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