冠心病患者阿司匹林抵抗的初步观察

Aspirin Resistance in Coronary Heart Disease Patients.

目的初步探讨冠心病患者的阿司匹林抵抗(AR)现象及其相关因素。方法经冠脉造影确诊为冠心病患者156例,服用阿司匹林100mg/d≥1周后,分别用花生四烯酸(AA)、二磷酸腺苷(ADP)作诱导剂检测血小板聚集率(PAG)。AA诱导的PAG≥20%,同时ADP诱导的PAG≥70%者为AR;仅符合其中一项为阿司匹林半抵抗(ASR);均不符合者为阿司匹林敏感(AS)。结果156例患者中AR发生率为22.44%(35例),ASR发生率是17.95%(28例),AS发生率是59.62%(93例)。AR+ASR组中的糖尿病患者所占比例(28.57%)较AS组(9.68%)多(P<0.05);AR+ASR组患者血浆总胆固醇、低密度脂蛋白-胆固醇浓度显著高于AS组(P<0.05)。结论服用小剂量阿司匹林的冠心病患者AR+ASR发生率为40.38%;AR或ASR者血浆胆固醇浓度较高;糖尿病患者AR或ASR发生率较高。

Objective To investigate the phenomenon and influence factors of aspirin resistance（AR） in coronary heart disease （CHD） patients. Methods One hundred and fifty six patients with angiographically documented CHD took aspirin 100 mg/d for ≥7 days, and then their blood samples were collected for detemfinafion of optical platelet aggregation （PAG） using arachidonic acid （AA） and adenosine diphosphate（ADP） as inducer. AR was defined as a state in which PAG ≥120% with AA as inducer and PAG ≥70% with ADP as inducer. Aspirin semiresistance （ASR） was defined as meeting one of above two criteria. The condition was defined as aspirin sensitive（AS）, when both above criteria were not met. Results Of 156 CHD patients, 35 cases were AR （22.44%）, 28 cases were ASR （17.95%）, 93 cases were AS （59.62%）. There were more diabetic patients in AR ＋ ASR group titan in AS group （28.57% vs 9.68%, P 〈 0.005）. The plasma level of total cholesterol and LDL-C（mmol/L） in AR＋ ASR group was significandy higher titan that in AS group （5.00 ± 1.26 vs 4.54 ± 0.91, P 〈 0.05, 2.99 ± 0.95 vs 2.67 ± 0.64, P 〈 0.05, respectively）. Conclusion The incidence of AR ＋ ASR among CHD patients was 40.38%. The plasma level of total cholesterol and LDL-C in AR ＋ ASR group was higher than that in AS group. The incidence of AR ＋ ASR in diabetes meUitus patients was increased.