老年冠心病患者阿司匹林抵抗的相关危险因素分析

Analysis of risk factors for aspirin resistance study in elderly patients with coronary heart disease

目的 探讨老年冠心病人群中阿司匹林抵抗的发生率和相关危险因素.方法 采用比浊法,使用花生四烯酸（AA）和二磷酸腺苷（ADP）两种不同诱导剂测定129例老年冠心病患者的血小板功能.全自动生化仪检测血常规、凝血功能、C反应蛋白、血脂、血糖等生化指标.高压液相法测定糖化血红蛋白.将结果分为阿司匹林抵抗（AR）组、阿司匹林半抵抗（ASR）组和阿司匹林敏感（AS）组.分析各组间的临床资料,探讨与AR有关的危险因素.结果 AR的发生率为16.3％,ASR的发生率为31.0％,AS的发生率为52.7％.与AS组相比,AR＋ ASR组糖尿病患者明显增多,总胆固醇水平、餐前空腹血糖、糖化血红蛋白、C反应蛋白、纤维蛋白原等水平明显升高,差异有统计学意义（P＜0.05）.Logistic回归分析显示,空腹血糖和总胆固醇增高是AR的独立危险因素（P＜0.01和P＜0.05）.结论 老年冠心病患者发生AR可能与糖尿病、高脂血症及C反应蛋白、纤维蛋白原水平增高有关.

Objective To investigate the morbidity rate and the related risk factors of aspirin resistance in elderly patients with coronary heart disease.Methods A total of 129 elderly patients with coronary heart disease were enrolled in this study.Platelet aggregation was determined by adenosine diphosphate（ADP） and arachidonic acid induction.By using the automatic biochemical analyzer,we measured the blood test,coagulation function,CRP,blood lipid,blood glucose and so on.Also,we apply the high-pressure-liquid-method to determine the glycosylated hemoglobin.According to the meassurements,the patients are divided into three groups：aspirin resistance group （AR）,aspirin semiresponder group（ASR） and aspirin sensitivity group（AS）.Difference in clinical data were analyzed to find the related risk factors of AR.Results The incidence of AR,ASR and AS were 16.3％,31.0％ and 52.7％,respectively.There were more diabetic patients in AR and ASR groups than in AS group（P ＜ 0.05）.Compared with AS group,the proportion of patients with diabetes,total cholesterol （TC）,fasting blood-glucose,HbAlc,C-reactive protein（CRP）,fibrinogen（Fb） concentrations were increased statistically significantly in elderly patients with CAD of NAS group.Logistic regression analysis revealed that AR is likely correlated with increasing level of fasting blood-glucose and total cholesterol （P ＜ 0.01 and P ＜ 0.05）.Conclusion Aspirin resistance is likely correlated with diabetes mellitus,hyperlipidaemia,increased CRP and fibrinogen concentrations in elderly patients with CAD.