阿司匹林抵抗试验在老年心血管高危患者中的临床价值

A laboratory research of aspirin resistance in eldly patients with high risk of cardiovascular dis- ease

目的比较不同阿司匹林抵抗试验对老年心血管高危患者阿司匹林疗效判断及其临床应用价值。方法对202例长期规律口服阿司匹林的老年心血管高危患者分别进行光学法检测血小板聚集率（PAgT）、血栓弹力图（TEG）、血小板功能分析仪-100（PFA-100）及P-选择素（P—selectin）表达的检测，并将各试验结果进行对比分析。结果阿司匹林抵抗组患者光学法检测血小板聚集率、P-选择素表达率及PFA-100结果均显著高于阿司匹林敏感组患者（P〈0．05）。与PA灯及PFA-100相比，TEG对阿司匹林抵抗检出的敏感性和特异性更高，与临床事件的一致性最高。结论光学法检测血小板聚集率判断阿司匹林的疗效，以花生四烯酸作为诱导剂时更敏感、特异；TEG血小板图较传统光学法血小板聚集率有更好的敏感性，与临床事件的一致性高。

Objective To measure the clinical efficacy of aspirin between different test of plate- let function. Methods The AA and ADP induced platelet aggregation test （PAgT） , the thrombelastogra- phy platelet mapping test（ TEG）, the platelet function analyzer（PFA-100） and P-selectin were performed on the 202 elderly patients with high risk of cardiovascular disease who had been taking aspirin 100mg/d. Results The patients were divided into aspirin resistance group （AR）, aspirin semi-responders group （ASP） and aspirin sensitive group（AS）. Platelet aggregation rate and P-selectin level were significantly higher in AR group than in AS group（ P 〈 0.05 ）. The P-seletin level of AR detection by platelet aggrega- tion test and PFA-100 were significantly higher. The sensitivity of thrombelastography platelet mapping and PFA-100 were higher than platelet aggregation test. The consistency between thrombelastography platelet mapping and clinical event was the highest in all of test methods we used（ K = 0. 904 ,P 〈 0.001 ）. Con- clusion AA is the most sensitive reducer in optical platelet function measuring aspirin effcity. The throm- belastography platelet mapping test is another both sensitive and convenient method in measuring the platelet function in aspirin-taking elderly persons with high risk of cardiovascular disease.