不同实验方法调查431例老年患者阿司匹林抵抗患病率

Prevalence of laboratory aspirin resistance in 431 old patients

目的：评价常用的光比浊法与血栓弹力图法在诊断实验室阿司匹林抵抗（aspirin resistance,AR）的科学性及一致性;调查实验室阿司匹林抵抗在老年患者中的患病率。方法：入选了北京万寿路地区431例服用阿司匹林（75~100mg,≥1个月）,具有动脉粥样硬化血栓相关疾病的老年患者。采用光比浊法与血栓弹力图法筛查阿司匹林抵抗患者,计算其在服用阿司匹林患者中的发生率。AR诊断标准：1）花生四烯酸（AA）作诱导剂,血小板聚集率≥20%。2）二磷酸腺苷（ADP）作诱导剂,血小板聚集率≥70%。符合2项为AR;两项均不符合者为阿司匹林敏感。3）AA作诱导剂,血栓弹力图法检测AA聚集率≥50%为AR。结果：AA诱导光比浊法,AR患病率为13.69%。ADP诱导光比浊法,AR患病率30.16%。AA诱导血栓弹力图法,AR患病率23.67%。采用单一方法诊断AR一致性差（Kappa〈0.4）。采用AA诱导光比浊法联合ADP诱导光比浊法或AA诱导血栓弹力图法,AR患病率分别为8.35%和8.82%,二者诊断AR一致性较好（Kappa=0.793）。结论：AA诱导光比浊法联合ADP诱导光比浊法或AA诱导血栓弹力图法,在诊断AR时稳定性和一致性好,可能能够代表真实AR的发生率。在北京万寿路地区具有动脉粥样硬化血栓相关疾病的老年患者中,实验室AR的患病率为8%~9%。

Objective：To evaluate correlation between and agreement in light transmittance aggregation（LTA） and thromboelastography（TEG） in laboratory diagnosing aspirin resistance（AR）,and to determine the prevalence of AR in old patients.Methods：Patients in the Wanshoulu District of Beijing with ischemic atherothrombotic diseases were recruited.Inclusion criteria were age ≥ 65 years,and having received regular aspirin therapy（75–100 mg daily） for at least 4 weeks.On the basis of LTA assay,the definition of AR was taken as aggregation of≥ 20% with AA（arachidonic acid）,and of≥ 70% with ADP（adenosine diphosphate）.Aspirin-sensitivity was indicated by the absence of either of these criteria;aspirin-sensitivity was indicated as both criteria being met.The definition of AR by TEG is ≥50% via AA-induced whole blood aggregation. Results：There were 13.69% prevalence of aspirin resistance for LTA using AA as the agonist,30.16% prevalence of aspirin resistance for LTA using ADP as the agonist,and 23.67% prevalence of aspirin resistance for TEG using AA as the agonist.Results from these tests showed poor agreement（Kappa0.4）.However,by the method of LTA using AA and ADP as the agonists,prevalence of AR was 8.35%.By methods of AA-induced LTA and AA-induced TEG,prevalence of AR was 8.82%.Results from these two latter methods showed good agreement（Kappa = 0.793）.Conclusion：Combined methods,as described here,have good correlation and agreement in the assays of AR,and the results with them represent a realistic measure of the prevalence of AR.Prevalence of AR of elderly patients from Wanshoulu district of Beijing is about 9%.