阿司匹林抵抗的产生机制与防治策略

Pathogenesis and prevention tactics of aspirin resistance

阿司匹林属于非甾体类抗炎药，尽管被广泛应用于临床已有百余年，但有关其作用机制及临床应用的研究一直在进行。阿司匹林由最初的被用于解热、镇痛、抗炎等逐渐转变到用于抗血栓，尤其在心血管事件的二级预防中应用最广，减少了大约25％的心血管事件的发生。临床上有5％～60％的患者虽常规服用阿司匹林，却不能有效地抑制血小板的活性，这种现象被称为阿司匹林抵抗。导致这种现象的确切原因还不明确，可能与药物间的相互作用、剂量不足等有关。但到目前为止，仍无法用同一机制解释所有的阿司匹林抵抗，并且，很多研究所得出的结果是矛盾的。因此，认为在具有阿司匹林抵抗的人群中可能存在一定的群体特征性，也正因如此导致了阿司匹林抵抗的复杂性。期望用同一机制解释所有的阿司匹林抵抗现象是不可行的，应当针对不同群体做更多的研究工作。按照传统中医理论，结合心血管疾病多病程较长，且在存在阿司匹林抵抗的人群中多反复发作等特点，应将其归属于络病的范畴。联合应用具有扶正化浊，活血解毒通络功效的中药，发挥中医中药辨证论治和整体调节的优势，也许可以解决具有不同群体特征性的阿司匹林抵抗的问题，从而更有效地预防心血管疾病的发生。

Aspirin （acetylsalicylic acid） is a nonsteroidal anti-inflammatory drug. Despite its wide uses for more than 100 years, knowledge about mechanism of action and therapeutic issues of aspirin are still under discussion. The use of aspirin has been changed from an analgesic, anti-pyretic and anti-inflammatory agent to an anti-thrombotic agent, especially in secondary prevention of cardiovascular events. Aspirin has reduced the risk of cardiovascular events by 25%. However, the phenomenon of ＂aspirin resistance＂ has been described that in 5%-60% of patients aspirin may not achieve adequate efficacy of suppressing platelet activi- ty. The convinced causes of this phenomenon are still unknown. It is probably due to drugs interaction, inadequate dosage and so on. By far the existing studies of aspirin are insufficient to explain all phenomena of aspirin resistance. And the results are not always uniform about the same research. Therefore, the characteristics in different population with aspirin resistance may account for the complexity. It is unrealistic to elucidate all aspirin resistance by only one pathway. More studies are required to investigate the mechanisms in different population respectively. According to the theory of traditional Chinese medicine and the trait of cadiovascular disease, which often relapses and has a long history, aspirin resistance should be considered as collaterals disease. It can be treated with aspirin and traditional Chinese drugs which have the power to strengthen body resistance, reduce phlegm, remove blood stasis and toxic materials from meridians. The problem of aspirin resistance might be solved by this way, because the traditional Chinese medicine has the superiority of selecting appropriate therapeutic methods based on syndrome differentiation for different population and regulating the whole body＇s function. Subsequently, cadiovascular disease might be effectively prevented.