脑梗死患者阿司匹林抵抗的临床研究

目的评价脑梗死患者阿司匹林抵抗(AR)发生的情况,分析其临床有关因素,探讨可能机制。方法255例急性脑梗死患者,每日服用阿司匹林100mg,连服10d,服用最后1d后,24h内抽取空腹静脉血,分别用二磷酸腺苷(ADP)、花生四烯酸(AA)诱导做血小板聚集试验(PAgT),检测最大血小板聚集率(MAR)。结果患者中AR发生率8.24%,阿司匹林半敏感(ASR)者占30.59%,年长者及女性AR或ASR患者中女性敏感者居多;如有吸烟者较AR或ASR者居多(11.53%vs5.05%)。结论AR在脑梗死患者中确实存在。ASA用于抗血小板治疗及预防动脉硬化事件的脑血管病患者,若有AR存在,应及时换用其它安全有效的抗血小板制剂,因阿司匹林需要长期应用,今后预测AR及抗血小板治疗个体化,将是未来抗血小板治疗的研究方向。

Objective To evaluate the prevalence of aspirin resistance in patients with cerebral infarction and to analyse the mechanisms and clinical predictors of aspirin resistance. Methods Patients with cerebral infarction received 100mg/d of aspirin for 10 days. Aspirin resistance was analysed by examination of blood platelet aggregation induced by adenosine diphosphate（AD） and araehidonic acid （AA）. Results There were 8.24 % of the patients being aspirin resistant and 30.59% being aspirin semiresponders. Patients who were either aspirin resistant or aspirin semiresponders were most likely to be the elderly and women and more likdy to be smokers（ll . 53% vs5.05% P〈0.01） as compared with aspirin sensitive（AS） patients. Conclusion The detection of aspirin resistance is particularly important for the large number of patients relying on this medication for antiplatelet therapy and prevention of cerebrovaacular events. The safe alternative antiplatelet agent for long administration should be used if aspirin resistance appears, prediction of AR and individualization of antiplatelet therapy would be an emerging direction of antiplatelet therapy.