血栓弹力图检测老年高血压患者阿司匹林低反应性及相关因素研究

The Risk Factors Investigation of Aspirin Resistance in old patients with hypertension by Thrombelastography

目的评价血栓弹力图法(thrombelastography,TEG)对老年高血压患者阿司匹林低反应性(aspirin resistance,AR)的检测价值及相关影响因素,探讨AR与高血压患者血压控制水平的关系。方法选择2008年5月至2010年7月高血压患者340例,男223例,女117例,平均年龄(74.37±7.93)岁,服用阿司匹林(≥75 mg)至少大于1个月。TEG法检测血小板聚集功能并根据检测结果分为AR组和阿司匹林敏感(AS)组;流式细胞仪检测血小板活化指标CD62P、PAC-1水平,同时检测血常规、血生化、同型半胱氨酸、超敏C反应蛋白、B型脑钠肽前体等。结果 TEG法检测AR的发生率为24.12%,其中血压达标组为15.05%,血压不达标组为32.92%,血压不达标组AR的发生率显著升高(χ2=9.688,P=0.002)。与AS组比较,AR组不良心血管事件的发生率增高(63.41%vs 39.15%, 2=-0.216,P=0.003);CD62P水平升高[(21.82±23.05)vs(14.02±19.41),P=0.003];PAC-1水平较高[(49.16±29.32)vs(41.84±28.55),P=0.048];收缩压升高[(147.17±15.36)vs(139.70±16.75),P=0.032];空腹血糖水平升高[(6.54±1.67)vs(5.99±1.30),P=0.002)]。Logistic回归分析显示,收缩压、PAC-1、血糖为AR的独立危险因素。结论TEG法检测老年高血压患者AR发生率较高;AR的高血压患者血压控制水平较差。对于老年高血压患者,应强调积极有效降压同时积极有效使用阿司匹林及控制多种心血管危险因素。

Objective To evaluate the related risk factors for aspirin resistance in elderly patients with hypertension by using thrombelastography. Methods There hundreds and forty elderly patients aged （74.37±7.93）years,who received daily aspirin therapy （1〉 75 mg）for over 1 month,were recruited. Platelet aggregation was measured by thrombelastography platelet mapping assay （TEG）. Platelet activation was determined by platelet surface expression of PAC-1 and CD62P after natural activation using flow cytometry. The blood pressure,blood components,blood lipids and glucose were measured. Results （1）24.12% patients were aspirin-resistant. Aspirin resistance was present in 32.92% of the patients with poor blood pressure control,while in 15.05% of the patients with controlled blood pressure（x2=-9.688,P=-0.002）. （2）Patients with aspirin resistance had higher recurrent arterial thrombotic events during long-term follow-up than those of patients who were aspirin sensitive （63.41% vs 39.15%, 22=-0.216, P=0.003 ）. （3） The systolic pressure, CD62P, PAC-1, fasting blood glucose and triglyceride levels were significantly higher（P〈0.05, respectively）in aspirin-resistant patients. （4）Multivariate analysis revealed that systolic pressure （odds ratio OR 0.980 ;P=0.032）, PAC-1 levels （OR 0.980;P=0.001） and fasting blood glucose （OR 0.806;P-0.035）were independent predictors of aspirin resistance. Conclusion The prevalence of aspirin resistance in elderly hypertensive patients is high. Aspirin-resistant patients usually have poor systolic pressure control. It is important to emphasize not only on effective using aspirin but also on optimal blood and other risk factors control.