在脑梗死二级预防中阿司匹林抵抗的危险因素分析

Analysis of risk factors for aspirin resistance in the secondary prevention of cerebral infarction

目的探讨脑梗死二级预防患者的阿司匹林（ASA）抵抗可能的影响因素,为脑梗死的二级预防提供新的资料和参考指标。方法选取120例脑梗死患者和正常对照组56例,采用比浊法（LPT）,以＂ADP诱导和花生四烯酸诱导＂相结合的方法测定血小板聚集率,判定阿司匹林抵抗,并按血小板聚集率水平分为阿司匹林抵抗组（AR）、半抵抗组（ASR）、敏感组（AS）和正常组。分别记录患者性别、年龄、血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇等及糖尿病、既往脑梗死史。结果单因素分析显示,脑梗死各亚组的性别、年龄、糖尿病、短暂性脑缺血发作（TIA）、大动脉闭塞性脑梗死或腔隙性梗死（LAA）较正常组有差异,其中糖尿病（OR=13.297,95%CI 2.422-72.984,P=0.003）、既往有TIA史（OR=5.019,95%CI1.026-24.538,P=0.046）,为AR发生的独立危险因素。结论 AR与糖尿病、既往有TIA史有关,其中糖尿病与AR关系最密切。

Objective To investigate the related risk factors for aspirin resistance in the secondary prevention of cerebral infarction ,in order to provide new data and reference index in the future .Methods We recruited 120 patients with cerebral in‐farction and 56 healthy controls in our study and detected platelet aggregation rate by using turbidimetry method （LPT ） and combining ADP induction and arachidonic acid induction to judge aspirin resistance .All cases were divided into aspirin-resist‐ance（AR） group ,semi-resistance（ASR） group（ASR） ,aspirin-sensitivity （AS） group and normal group based on the level of platelet aggregation .At the same time ,we recorded patients’ age ,gender ,blood sugar ,total cholesterol ,triglyceride ,low densi‐ty lipoprotein cholesterol ,diabetes mellitus and cerebral infarction history .Results Univariate analysis showed that Gender , age ,diabetes ,transient ischemic attack（TIA） ,large-artery occlusion lacunar（LAA） in the AR ,ASR and AS groups showed sta‐tistical differences compared with those in the normal group .And diabetes as well as TIA history was the independent risk fac‐tor for AR（diabetes ：OR=13.297 ,95% CI 2.422 to 72.984 ,P=0.003;TIA history ：OR=5.019 ,95% CI 1.026 to 24.538 ,P=0.046） .Conclusion AR may have close relations with diabetes and previous TIA history ,among which diabetes is most closely related with AR .