阿司匹林抵抗的相关临床研究

Clinical correlation study on aspirin resistance

目的:探讨我国患病人群中阿司匹林抵抗(aspirin resistance,AR)现象,比较不同AR实验检测法对阿司匹林疗效的判断及其临床应用价值。方法:对264例口服阿司匹林的患者(高血压、糖尿病等)分别进行光学法血小板聚集率(platelet aggregation test,PagT)、血栓弹力图(thrombelastography,TEG)、血和尿11-脱氢-血栓素B2(11-dehydro thromboxane B2,11-DH-TXB2)及P-选择蛋白表达检测,并对比分析患者的AR发生率、相关危险因素及AR与临床终点事件间的相关性。结果:口服阿司匹林患者采用各种方法检测到的AR发生率基本一致(P>0.05)。糖尿病患者AR和阿司匹林半抵抗(aspirin semi-resistance,ASR)的检出率有高于其他疾病组的趋势。低密度脂蛋白和空腹血糖的升高是AR的危险因素。几种检测方法的结果间有一定相关性(r为0.408～0.709,P<0.01)。以P-选择蛋白阳性为标准,TEG较其他检测方法有更高的灵敏度(89.29%)和特异度(92.31%),且与P-选择蛋白阳性间的一致性更高(K值为0.904,P<0.001)。结论:低密度脂蛋白升高和空腹血糖升高是AR发生的危险因素,TEG血小板图对AR检出的灵敏度较高,与P-选择蛋白检测结果间的一致性较高。

Objective To study the aspirin resistance phenomenon in our patient group and to assess the value of various aspirin resistance tests in judging the therapeutic efficacy of aspirin. Methods In 264 patients taking aspirin orally, platelet aggregation test （PAgT）,thrombelastography （TEG）,levels of serum and urinary 11-dehydro thromboxane B2 （11-DH-TXB2） and P-selectin were determined,and the frequency of aspirin resistance, relevant risk factors and correlation between aspirin resistance and clinical end point were analyzed. Results The detection rates of aspirin resistance by various tests were basically the same （P〉0.05）. The trend of aspirin resistance and aspirin semi-resistance was higher in patients with diabetics than in other patient groups. High low density lipoprotein and fasting blood glucose were the risk factors of aspirin resistance. Correlation was found between these tests （r：0.408-0.709,P〈0.01）.TEG was more sensitive （89.29%） and specific （92.31%）than other tests and more in consistent with P-selectin （K = 0.904, P〈0.001） . Conclusions High low density lipoprotein and fasting blood glucose are the risk factors of aspirin resistance. The occurrence of thrombotic events is higher in cardiovascular patients with aspirin resistance than those without aspirin resistance. TEG is more sensitive and specific, and more in consistent with P-seleetin.