阿司匹林抵抗与大动脉粥样硬化型脑梗死复发的相关性研究

Influencing factors of recurrence of large atherosclerotic cerebral infarction and its relationship with aspirin resistance

目的探讨大动脉粥样硬化型脑梗死(LAA)复发的影响因素,并分析其与阿司匹林抵抗(AR)的相关性。方法选取漯河市中心医院2019-01—08收治的200例大动脉粥样硬化型脑梗死患者为研究对象,根据脑梗死有无复发分为LAA未复发组(158例)和LAA复发组(42例)。所有患者口服阿司匹林治疗,采用阿司匹林药物基因检测,PEAR1(G>A)基因型,检测结果示GG野生型对阿司匹林应答较好,AG突变杂合型应答不佳。对患者进行为期1 a的随访调查,多因素Logistic回归分析LAA复发的相关影响因素,并采用Spearman分析LAA复发与AR的相关性。结果LAA复发患者的年龄、糖尿病比例、AR比例、抗血小板药物依从性差比例及TC、Hcy水平显著高于LAA未复发患者,差异有统计学意义(P<0.05)。随访1 a内42例LAA复发患者中AR组26例(61.90%),显著多于AS组的16例(38.10%),差异有统计学意义(P<0.05);158例LAA未复发患者中AR组25例(15.82%),显著少于AS组的133例(84.18%),差异有统计学意义(P<0.05)。Logistic回归方程分析显示,患者年龄、糖尿病、AR、抗血小板药物依从性差、TC、Hcy均为LAA复发的独立危险因素(P<0.05)。患者年龄、糖尿病、AR、抗血小板药物依从性差、TC、Hcy与LAA复发呈显著正相关(P<0.05)。结论患者年龄、糖脂代谢、AR、抗血小板药物依从性差等各项因素均能增加LAA患者复发风险。

Objective To investigate the influencing factors of recurrence of large atherosclerotic cerebral infarction(LAA),and to analyze its correlation with aspirin resistance(AR).Methods Two hundred patients with large atherosclerotic cerebral infarc⁃tion admitted to our hospital from January 2019 to August 2019 were selected as the research objects.According to the recurrence of cerebral infarction,they were divided into LAA non-recurrence group(158 cases)and LAA recurrence group(42 cases).All pa⁃tients were treated with oral aspirin,and were divided into aspirin resistance group(AR group)and aspirin sensitive group(AS group)according to aspirin pharmaucogentic test.A one-year follow-up survey was conducted on the patients.Multivariate Logistic regression was used to analyze the related factors of LAA recurrence,and Spearman analysis was used to analyze the correlation be⁃tween LAA recurrence and AR.Results The age,the proportion of diabetes,the proportion of AR,the proportion of poor compliance with antiplatelet drugs,and the levels of TC and Hcy of patients with LAA recurrence were significantly higher than those of patients without LAA.There was a statistical difference between the two(P<0.05).Within 1 year of follow-up,among 42 patients with LAA recurrence,26 patients in the AR group(61.90%)were significantly more than 16 patients in the AS group(38.10%).There was a statistical difference between the two(P<0.05);158 patients with LAA did not relapse among the patients,25 cases(15.82%)in the AR group were significantly less than the 133 cases(84.18%)in the AS group.There was a statistical difference between the two(P<0.05).The Logistic regression equation was used to analyze the influencing factors of LAA recurrence.The patient’s age,diabetes,AR,poor compliance with antiplatelet drugs,TC,and Hcy were all independent risk factors for LAA recurrence(P<0.05).The patient’s age,diabetes,AR,and poor compliance with antiplatelet drugs were significantly positively correlated with LAA recurrence,and TC and Hcy were significantly positively correlated with LAA recurrence(P<0.05).Conclusion The factors of age,glucose and lipid me⁃tabolism and poor compliance of AR,antiplatelet drugs can increase the risk of recurrence in LAA patients.