老年查体人群抗血小板药物应用的现况分析

Inventory survey of antiplatelet drugs application among the elderly taking physical examination

目的：调查分析老年查体人群中抗血小板药物应用现况及起效概况。方法入选2015年6月至2015年8月期间在解放军总医院南楼体检的老年人（≥60岁）共955人。依据是否服用抗血小板药物及药物种类分为4组：阿司匹林组（n＝368），氯吡格雷组（n＝115），双抗（阿司匹林和氯比格雷）组（n＝43）和无药物组（n＝429）。收集基线资料并完成血栓弹力图（ TEG）测定，描述分析抗血小板药物应用及有效性情况，探讨影响抗血小板疗效的相关临床指标。结果4组人群间的年龄分布、吸烟者比例以及具有卒中、冠心病、糖尿病、高脂血症病史者的比例、白细胞（ WBC）计数、血小板（ PLT）计数、总胆固醇、低密度脂蛋白胆固醇（LDL－C）、空腹血糖、肌酐、估算肾小球滤过率（eGFR）和糖化血红蛋白（HbA1c）差异有统计学意义（P＜0．05），而凝血指标差异无统计学意义（P＞0．05）。阿司匹林组的花生四烯酸（AA）途径几近起效，氯吡格雷组的二磷酸腺苷（ADP）途径以及双抗组的AA途径和ADP途径均在起效范围内。氯吡格雷组的有效率显著高于阿司匹林组（76．52％ vs 45．92％），差异具有统计学意义（P＜0．05）。 logistic回归分析发现WBC、PLT、活化部分凝血活酶时间（APTT）和LDL－C增加出血风险，年龄、PLT、eGFR、HbA1c和APTT增加血栓风险。结论抗血小板药物的使用现况较为满意，可使老年人获益。

Objective To investigate the current application and effectiveness of antiplatelet drugs in elderly people taking physical examination.Methods A total of 955 elderly patients （≥60 years old） who taking physical examination in our hospital from June to August 2015 were enrolled in this cross-sectional study .They were divided into 4 groups by treatment scheme , that is, aspirin group （n=368）, clopidogrel group （n=115）, dual-drug group （aspirin＋clopidogrel, n=43）, and non-drug group （n=429）.Their baseline clinical data and the results of thrombelastography （TEG） were collected.The application and effectiveness of the antiplatelet agents were analyzed , and the related clinical indicators influencing drug efficacy were investigated .Results Significant differences were found in the age distribution, proportions of smokers, and those with the medical history of stroke, coronary heart disease,diabetes mellitus, hyperlipidemia, as well as white blood cell count （WBC）, platelet count （PLT）, total cholesterol, low-density lipoprotein cholesterol （ LDL-C ） , fasting blood glucose （ FBG ） , creatinine , estimated glomerular filtration rate （ eGFR ） and glycosylated hemoglobin （HbA1c） （P〈0.05）, but not in the blood coagulation index （P〉0.05）.In aspirin group, the arachidonic acid （AA） pathway was nearly effective .The adenosine diphosphate （ ADP ） pathway was within the scope of effectiveness in the clopidogrel group.The ADP and AA pathway were both effective in the dual-drug group.The effectiveness was more significant in the clopidogrel group than in the aspirin group （76.52% vs 45.92%, P〈0.05）.Logistic regression analysis found that WBC , PLT, LDL-C and activated partial thromboplastin time （ APTT） increased the risk of bleeding , while age, PLT, eGFR, HbA1c, and APTT increased the risk of thrombus .Conclusion The current application of antiplatelet agents is satisfying , which can bring benefit to the elderly .