乙酰水杨酸抗血小板作用的争议与研究策略

Anti-platelet Effect of Aspirin-Contentions and Research Strategies

70年代以来,乙酸水杨(ASA)广泛用于预防缺血性心脑血管病急症(EICCVD),并有大量报道.这类ASA抗血小板聚集作用的临床报道或多或少存在设计不够严谨、结论不完全一致的问题.但是,大量的临床观察也获得了不少新的成果,从而进一步认识EICCVD病理、生理、ASA药效学和药动学的规律,发现有效地预防EICCVD除了抗血小板聚集之外,还应注意血脂、血液流变、动脉管壁病理变化性质与部位、饮食嗜好、遗传、AsA抗血小板聚集的个体和性别差异及不稳定的量效关系等问题.这些发现和争议提示以ASA预防EICCVD存在适应证选择、剂量方案设计、治疗监测等个体化用药要求;对人群而言,开展ASA抗栓作用的药物流行病学调查,促进其合理应用,对减少居我国人口死亡原因前几位的心脑血管病急症更具有重大药物经济学意义.

Since 1970s, aspirin has been widely used for emergency prevention in ischemic cerebro-cardiovascular disease(EICCVD), a lot of papers have been published. Because of their design shortcomings, these reports failed to reach a consensus on the dosage or effects of aspirin. Fortunately, new clues were found in these observations. i.e. physiopathological changes of EICCVD and pharmacodynamics pharma-cokinetics of aspirin. It was suggested that attention should not only be paid to anti-platelet effect but also to the changes of blood lipids, hemorrheological properties, pathological characteristics and sites of arteriosclerosis , dietary habits, genetics, sex and individual differences which were ascribed to the unstable dose-effect relationship of aspirin's anti-platelet action. These results show that the indications, dosage regimen and therapeutic monitoring are needed for EICCVD patients treated by aspirin. A pharmaco-epidemiologicl investigation on antiplatelet effect of aspirin for rational use of the drug is phamaco-economically significant in view of the fact that EICCVD are leading causes of death in urban population in China.