老年冠心病合并高同型半胱氨酸血症患者阿司匹林抵抗发生率及危险因素调查

Incidence rate of aspirin resistance in elderly patients with coronary heart disease complicated by hyperhomocysteinemia and related risk factors

目的分析老年冠心病合并高同型半胱氨酸血症患者的阿司匹林抵抗发生率,并探讨其危险因素。方法选取2015年1月至2017年5月我科门诊及收治住院的185例老年冠心病患者,其中合并高同型半胱氨酸血症的患者108例未合并高同型半胱氨酸血症的患者77例;AR24例,AS161例。通过对比Hhcy患者和非Hhcy患者及AR和AS患者的各项临床指标,分析患者的阿司匹林抵抗发生率,并对其危险因素进行探讨。结果 Hhcy患者的糖尿病发病率显著低于非Hhcy患者,Hcy水平、CD62P水平、肌酐水平均显著高于非Hhcy患者,AR发生率、服用钙拮抗剂比例均明显高于非Hhcy患者,以上各项组间比较差异均具有统计学意义(P<0.05)。AR患者的Hhcy比例为75.00%(18/24)明显高于AS患者55.90%(90/161),组间比较差异均具有统计学意义(P<0.05)。经多元Logistic回归分析显示,Hhcy是引起AR发生的独立危险因素(OR=2.405,95%CI:1.201~4.820,P=0.012);以hcy水平为因变量经多元线性回归分析显示,hcy水平与肌酐水平、患者年龄及BMI呈正相关关系(P<0.05,见表2所示)。经相关性分析显示,hcy水平与AA诱导的血小板聚集率呈正相关趋势(r=0.030,P=0.565)。结论老年冠心病合并高同型半胱氨酸血症患者的AR发生率显著增加,高同型半胱氨酸血症是老年冠心病患者AR发生的高危因素。

Objective To investigate the incidence rate of aspirin resistance （AR） in elderly patients with coronary heart disease complicated by hyperhomocysteinemia （HHcy） and related risk factors. Methods A total of 185 elderly patients with coronary heart disease who were admitted to our hospital from January 2015 to May 2017 were enrolled, and among these patients, 108 had HHcy and 77 had no HHcy. Of all patients, 24 bad AR and 161 had aspirin sensitivity （AS）. Clinical indices were compared between HHcy patients and non-HHcy patients, as well as between AR patients and AS patients, to analyze the incidence rate of AR and identify related risk factors. Results Compared with the non-HHey patients, the HHcy patients had a significantly lower incidence rate of diabetes, significantly higher levels of homocysteine （Hey）, CD62P, and creatinine, a significantly higher incidence rate of AR, and a significantly higher proportion of patients treated with calcium antagonists （all P〈0.05）. The AR group had a significantly higher proportion of patients with HHey than the AS group [75.00% （18/24） vs 55.90% （90/161）, P〈0.05]. The multivariate logistic regression analysis showed that HHcy was an independent risk factor for AR （odds ratio=2.406, 95% confidence interval 1.201- 4.820, P=-0.012）; the multivariate linear regression analysis with Hey level as a dependent variable showed that Hey level was positively correlated with creatinine level, age, and body mass index （all P〈0.05）. The correlation analysis showed that Hey level was positively correlated with platelet aggregation rate induced by arachidonic acid （r=0.030, P=0.565）. Conclusion Elderly patients with coronary heart disease complicated by HHcy have a significant increase in the incidence rate of AR, and HHcy is a high risk factor for AR in elderly patients with coronary heart disease.