阿司匹林不同服药时间对缺血性脑卒中患者血小板功能的影响

Effects of different aspirin medication time on platelet function of patients with ischemic stroke

目的:观察日间或夜间服用阿司匹林对缺血性脑卒中患者血小板聚集率变化的影响。方法:将84例缺血性脑卒中患者随机分为日间组(n=42)和夜间组(n=42)。两组患者均口服100 mg/d阿司匹林进行抗血小板治疗,日间组于上午8:00服用,夜间组于晚上20:00时服用;治疗7 d后,使用血栓弹力图检测两组患者24 h内5个不同时间点花生四烯酸(AA)诱导的血小板抑制率。结果:两组患者AA诱导的血小板抑制率比较,差异有统计学意义(F组间=26.425,P=0.001),两组血小板抑制率均随时间变化而变化(F时间=107.36,P=0.001),且两组血小板抑制率变化趋势不同(F交互=48.392,P=0.001);夜间组10:00时,AA诱导的血小板抑制率高于日间组,差异有统计学意义(P<0.05);随访12个月内,日间组复发脑梗死2例,夜间组复发脑梗死1例,差异无统计学意义(P>0.05),日间组1例患者出现全因性死亡,夜间组无全因性死亡患者,两组比较差异无统计学意义(P>0.05)。结论:缺血性脑卒中患者日间和夜间服用阿司匹林对血小板聚集率变化影响不同,夜间服用阿司匹林能消除晨起血小板聚集高峰,更契合心脑血管病发作时间特点。

Objective:To observe effects of different aspirin medication time(daytime or nighttime)on changes in platelet aggregation rate of patients with ischemic stroke.Methods:84 patients with ischemic stroke were enrolled.They were randomly divided into daytime group(n=42)and nighttime group(n=42).Both groups were given oral 100 mg/d aspirin for anti-platelet therapy.The medication time in daytime group and nighttime group was 8:00 am and 20:00 pm,respectively.After 7d of treatment,thromboelastography was applied to detect platelet inhibition rates induced by arachidonic acid(AA)at five different time points within 24h in both groups.Results:There were differences in AA-induced platelet inhibition rate between the two groups integrally(F between groups=26.425,P=0.001).The platelet inhibition ratesin both groups were changed with time changing(F time=107.36,P=0.001).The change trends of platelet inhibition rate in both groups were different(F interaction=48.392,P=0.001).AA-induced platelet inhibition rate at 10∶00 in nighttime group was higher than that in daytime group(P<0.05).Within 12-month follow-up,there were 2 cases and 1 case with recurrent cerebral infarction in daytime group and nighttime group,respectively(P>0.05).There was 1 patient with all-cause death in daytime group,while there was no case with all-cause death in nighttime group(P>0.05).Conclusion:The effects of taking aspirin at daytime and nighttime are different on changes of platelet aggregation rates in patients with ischemic stroke.Taking aspirin at nighttime can eliminate peak of platelet aggregation in the morning and better fit onset features of cardiovascular and cerebrovascular diseases.