急性脑梗死合并高同型半胱氨酸血症患者阿司匹林抵抗及相关因素分析

Analysis of aspirin resistance and its related factors in patients with acute cerebral infarction complicated with high level of homocysteine

目的观察急性脑梗死(ACI)患者合并高同型半胱氨酸血症(Hhcy)阿司匹林抵抗(AR)发生情况及相关因素。方法 2014年9月—2015年12月本院神经内科收治的急性脑梗死(ACI)患者146例为研究对象,根据同型半胱氨酸(Hcy)水平分为两组:Hhcy组(观察组)78例,非Hhcy组(对照组)68例,入院后两组均服阿司匹林100mg.d^(-1),连服1个月后,检测血常规、凝血常规和血小板聚集率,进行阿司匹林的疗效评价,AR定义为花生四烯酸诱导的血小板聚集率≥20%。结果 Hhcy组AR发生率为21.8%,明显高于非Hhcy组8.8%,两者相比差异有统计学意义(P<0.05)。Logistic回归分析显示,Hhcy是发生AR的独立危险因素(β=-0.58,P<0.01)。结论 ACI患者合并Hhcy的AR发生率明显增加,Hhcy是ACI患者发生AR的重要危险因素。临床工作中应给予充分重视,积极检测血清Hcy水平,积极监测血小板聚集率,预测AR,避免或延缓血栓性疾病的发生。

Objective To observe the incidence and related factors of aspirin resistance（AR） in patients with acute cerebral infarction complicated with high level of hyperhomocysteinemia（Hhcy）. Method 146 cases of acute cerebral infarction（ACI） treated in our hospital from 2014.09-2015.12 were studied, which were divided into two groups according to the level of homocysteine： Hhcy group（observation group） cases of 78 cases, non Hhcy group（control group） of 68 cases, aspirin 100 mg.d-1 were taken of the two groups after admission, blood routine examination, blood coagulation and platelet aggregation rate were examined after 1 month. the efficacy of aspirin were evaluated, AR is defined as four arachidonic acid induced platelet aggregation rate more than 20% Results The incidence rate of AR in the Hhcy group was 21.8%,which was significantly higher than that in the non Hhcy group of 8.8%, there was significant differences compared with the two groups（P〈0.05）. Logistic regression analysis showed that Hhcy was an independent risk factor for AR（β=-0.58,P〈0.01）. Conclusion The incidence of AR in patients is significantly increased in ACI patients with Hhcy, and Hhcy is an important risk factor for the occurrence of AR in ACI patients. Full attention should be paid to the clinical work, positive detection of serum homocysteine levels, and actively monitoring platelet aggregation rate, prevention and treatment of AR, avoid or delay the occurrence of thrombotic diseases.