慢性肾衰竭血透患者阿司匹林抵抗状况研究

Study on the resistance of aspirin in patients with chronic renal failure

目的观察慢性肾衰竭行维持性血液透析(MHD)患者阿司匹林抵抗(AR)的发生情况及影响因素。方法选择332例慢性肾衰竭行MHD患者进行研究,将其中凝血功能检测呈高凝与正常状态患者260例作为观察组,同时选取估算的肾小球滤过率(e GFR)>90 m L/(min·1.73/m2)且肾功能正常无损伤者260例作为对照组。采集所有患者的一般资料、生化指标、颈动脉超声与血栓弹力图,以花生四烯酸类药物抑制率[MA(AA)]>50%判定为AR。根据患者是否发生AR,将观察组患者分为抵抗组125例和敏感组135例,分析慢性肾衰竭行MHD患者发生AR的危险因素。根据超声结果选择抵抗组中118例和敏感组中128例颈动脉内膜增厚或颈动脉斑块形成患者进行随访,分析阿司匹林失效事件的发生情况。结果 332例慢性肾衰竭行MHD患者中呈高凝状态者15例占4.52%,正常凝血者245例占73.80%,低凝状态者72例占21.69%。观察组患者的hs-CRP、Hcy、R值均高于对照组(P均<0.05),而MA值明显低于对照组(P<0.05)。观察组AR发生率显著高于对照组(P<0.01)。抵抗组和敏感组患者的年龄、性别、糖尿病、心脑血管病史、外周血管病史、内瘘血栓形成、发生颈动脉斑块、透析时间、FBG、hs-CRP、IMT、Hcy、R值、MA值比较差异均有统计学意义(P均<0.05)。Logistic回归分析发现年龄、糖尿病、透析时间、hs-CRP、Hcy是慢性肾衰竭行MHD患者发生AR的独立危险因素(P均<0.05)。颈动脉内膜增厚或颈动脉斑块形成的慢性肾衰竭行MHD患者随访(18.41±5.25)个月,抵抗组失效事件发生率显著高于敏感组(P<0.01)。Cox回归分析显示AR是伴有动脉内膜增厚或颈动脉斑块形成慢性肾衰竭行MHD患者发生失效事件的危险因素(P<0.05)。结论慢性肾衰竭行MHD患者AR发生率明显升高,年龄、糖尿病、透析时间、hs-CRP、Hcy是发生AR的独立危险因素。发生AR的慢性肾衰竭行MHD患者心脑血管事件以及内瘘血栓形成的发生率显著增加,AR是伴有动脉内膜增厚或颈动脉斑块形成慢性肾衰竭行MHD患者发生失效事件的危险因素。

Objective It is to observe the incidence and influence factors of aspirin resistance （AR） in patients with chronic renal failure （ MHD）. Methods 332 patients with chronic renal failure accepted MHD treatment were selected. The detection of coagulation function was high pour point and normal state of 260 cases of patients as the observation group, the estimated glomerular filtration rate （GFR） 〉 90 mL/min - 1.73/m^2 and renal funetion normal nondestructive injured 260 cases as the control group. The general data, bioehemical parameters, carotid ultrasound and thrombus elasticity map of all patients were collected, and the inhibition rate of [ MA （AA）] 〉 50% by peanut four was determined as AR. According to patients with AR, the observation group was divided into 125 eases of resistance group and 135 cases of sensitive group, the risk factors of AR in patients with chronic renal failure were analyzed by MHD. According to the results of ultrasound, 128 patients in the resistant group and 118 cases in the sensitive group were followed up for the carotid intimal hyperplasia or carotid plaque formation, and the oeeurrenee of aspirin failure was analyzed. Results 332 cases of chronic renal failure patients with MHD in patients with high blood coagulation status were 15 cases, 245 cases of normal coagulation, 73.80% cases, 72 eases of low coagulation status accounted for 21.69%. The Hey, R and hs - CRP values of the patients were significantly higher than that of the eontrol group （P 〈 0.05） , while the MA values were significantly lower than those in the control group （P 〈 0. 05）. The incidence of AR in the observation group was significantly higher than that in the control group （P 〈 0.01 ）. Group and sensitive group of patients, the age, gender, diabetes, cerebrovascular disease, peripheral vascular disease resistance, fistula thrombosis, carotid plaque, dialysis duration, FBG, hs CRP and IMT, Hcy, R value and Ma value differences were statistically significant （P 〈 0.05）. Logistic regression analysis showed that age, diabetes, dialysis time, Hcy, and hs - CRP were the independent risk factors for AR in patients with chronic renal failure （P 〈 0.05 ）. The incidence of chronic renal failure patients with carotid artery intima-thickening or carotid plaque formation was significantly higher than that of the susceptible group （ P 〈 0.01 ） in the follow-up of patients with chronic renal failure （ 18.41 5.25 ） months. Cox regression analysis showed that AR was a risk factor （P 〈 0.05） for the occurrence of chronic renal failure patients with chronic renal failure accompanied by carotid artery intimal thickening or carotid plaque formation （MHD）. Conclusion The incidence of AR in patients with chronic renal failure was significantly increased, and the age, diabetes, dialysis time, hs -CRP and Hcy were the independent risk factors for AR.. Ar chronic renal failure undergoing MHD patients with cardiovascular and cerebrovascular events and fistula thrombosis incidence increased significantly, AR is associated with arterial intimal thickening or carotid artery plaque formation in the event of a failure event risk factors to the patients with chronic renal failure undergoing MHD.