老年缺血性脑血管病患者阿司匹林抵抗发生率及影响因素分析(1)
[摘要] 目的 探讨老年缺血性脑血管病患者阿司匹林抵抗(AR)发生率及其影响因素。 方法 研究对象为新乡医学院第三附属医院神经内科2013年1月～2015年1月就诊的口服阿司匹林1个月以上的老年缺血性脑血管病患者380例。对患者进行血栓弹力图(TEG)检测，把花生四烯酸(AA)诱导血小板聚集率50%及以上定义为AR，50%以下定义为阿司匹林敏感(AS)。统计了AR发生率，对AR患者(30例)与阿司匹林敏感(AS)患者(350例)的年龄、性别、血糖、血脂等指标进行了多因素logistic回归分析。 结果 AR发生率为7.89%；AR患者不良事件发生率为56.67%，显著高于AS患者的30.00%(P < 0.05)。AR患者中女性比例为53.33%，显著高于AS患者的31.14%(P < 0.05)；AR患者空腹血糖、P选择素分别为(6.45±1.54)mmol/L、(25.24±16.25)%，均显著高于AS患者的[(5.85±1.28)mmol/L、(18.78±15.01)%]，差异有统计学意义(P < 0.05)。多因素Logistic回归分析结果，性别为女性(OR=5.094，95%CI：2.080～12.475)、空腹血糖(OR=3.850，95%CI：2.313～6.408)、P选择素(OR=2.812，95%CI：1.747～4.528)为AR发生的独立影响因素。 结论 TEG检测老年缺血性脑血管病患者AR发生率不高，其发生与患者性别、空腹血糖、P选择素有关。
[关键词] 缺血性脑血管疾病；阿司匹林抵抗；血栓弹力图；影响因素
[中图分类号] R973 [文献标识码] A [文章编号] 1674-4721(2016)08(c)-0156-04
[Abstract] Objective To investigate the incidence and effect factors of aspirin resistance (AR0 in elderly patients with ischemic cerebrovascular diseases. Methods The study subjects were 380 elderly patients with ischemic cerebrovascular diseases who were treated orally with aspirin in the Department of Internal Medicine of Third Affiliated Hospital of Xinxiang Medical College from January 2013 to January 2015. The patients were examined by thrombelastogram (TEG). The rate of platelet aggregation induced by arachidonic acid (AA) was ≥50% was defined as AR， and <50% was defined as aspirin sensitivity (AS). The incidence of AR (30 cases) was statistically analyzed. Age， gender， blood glucose， blood lipid and other indexes were compared between patients with AR (30 cases) and aspirin sensitivity (AS， 350 cases). Multivariate logistic regression analysis was performed to analyze the effect factors. Results The incidence of AR was 7.89%； the incidence of adverse events in patients with AR (56.67%) was significantly higher than that in patients with AS (30.00%) (P < 0.05). The proportion of female patients with AR (53.33%) was significantly higher than that of patients with AS (31.14%) (P < 0.05)； the fasting blood glucose and P selectin in patients with AR [(6.45±1.54) mmol/L， (25.24±16.25)%] were significantly higher than those in patients with AS [(5.85±1.28) mmol/L， (18.78±15.01)%] (P < 0.05). Multivariate logistic regression analysis showed that female (OR=5.094， 95%CI： 2.080-12.475)， fasting blood glucose (OR=3.850， 95%CI：2.313-6.408) and P selectin (OR=2.812， 95%CI： 1.747-4.528) were independent effect factors of AR in elderly patients with ischemic cerebrovascular diseases. Conclusion The detection rate of AR by TEG in elderly patients with ischemic cerebrovascular diseases is not high. The occurrence is correlated with gender， fasting blood glucose and P selectin. (靳玫 马世江 沈长波 王文晟)
[关键词] 缺血性脑血管疾病；阿司匹林抵抗；血栓弹力图；影响因素
[中图分类号] R973 [文献标识码] A [文章编号] 1674-4721(2016)08(c)-0156-04
[Abstract] Objective To investigate the incidence and effect factors of aspirin resistance (AR0 in elderly patients with ischemic cerebrovascular diseases. Methods The study subjects were 380 elderly patients with ischemic cerebrovascular diseases who were treated orally with aspirin in the Department of Internal Medicine of Third Affiliated Hospital of Xinxiang Medical College from January 2013 to January 2015. The patients were examined by thrombelastogram (TEG). The rate of platelet aggregation induced by arachidonic acid (AA) was ≥50% was defined as AR， and <50% was defined as aspirin sensitivity (AS). The incidence of AR (30 cases) was statistically analyzed. Age， gender， blood glucose， blood lipid and other indexes were compared between patients with AR (30 cases) and aspirin sensitivity (AS， 350 cases). Multivariate logistic regression analysis was performed to analyze the effect factors. Results The incidence of AR was 7.89%； the incidence of adverse events in patients with AR (56.67%) was significantly higher than that in patients with AS (30.00%) (P < 0.05). The proportion of female patients with AR (53.33%) was significantly higher than that of patients with AS (31.14%) (P < 0.05)； the fasting blood glucose and P selectin in patients with AR [(6.45±1.54) mmol/L， (25.24±16.25)%] were significantly higher than those in patients with AS [(5.85±1.28) mmol/L， (18.78±15.01)%] (P < 0.05). Multivariate logistic regression analysis showed that female (OR=5.094， 95%CI： 2.080-12.475)， fasting blood glucose (OR=3.850， 95%CI：2.313-6.408) and P selectin (OR=2.812， 95%CI： 1.747-4.528) were independent effect factors of AR in elderly patients with ischemic cerebrovascular diseases. Conclusion The detection rate of AR by TEG in elderly patients with ischemic cerebrovascular diseases is not high. The occurrence is correlated with gender， fasting blood glucose and P selectin. (靳玫 马世江 沈长波 王文晟)