老年女性LAA脑梗死阿司匹林抵抗的危险因素分析

An analysis of risk factors for aspirin resistance in elderly females with large-artery atherosclerotic cerebral infarction

目的 探讨老年女性大动脉粥样硬化型(LAA)脑梗死病人发生阿司匹林抵抗(AR)的危险因素,以期为个体化治疗提供依据。方法 选取2015年1月—2020年9月在青岛大学附属医院治疗的老年女性LAA脑梗死病人308例。所有入选病人均给予阿司匹林肠溶片100 mg/d, 7 d后采用血栓弹力图测定花生四烯酸(AA)途径的血小板聚集抑制率(AA抑制率),并根据AA抑制率将入选病人分为AR组和阿司匹林敏感(AS)组。采用单因素分析、多因素Logistic回归分析筛选LAA脑梗死病人发生AR的危险因素。结果 308例LAA脑梗死病人中发生AR者74例(24.0%),AS者234例。单因素分析显示,AR组有糖尿病史者的比例、纤维蛋白原(FIB)以及D-二聚体(D-D)水平明显高于AS组,差异具有统计学意义(χ^(2)=4.147,t=2.529,U=5 470.500,P<0.05)。多因素Logistic回归分析显示,糖尿病史及高水平D-D是AR发生的独立危险因素。结论 糖尿病史和D-D水平为AR的独立影响因素,二者有利于早期识别AR高风险人群。

Objective To explore the risk factors for aspirin resistance(AR)in elderly females with large-artery atherosclerotic(LAA)cerebral infarction,and to provide a basis for individualized treatment.Methods A total of 308 elderly female patients with LAA cerebral infarction who were treated in The Affiliated Hospital of Qingdao University from January 2015 to September 2020 were enrolled in the study.All the patients included were given enteric-coated aspirin tablets 100 mg/d and were tested for the inhibition rate of arachidonic acid(AA)-induced platelet aggregation(AA inhibition rate)using thromboelastography(TEG)after 7 days;the patients were then divided into AR group and aspirin-sensitive(AS)group according to the AA inhibition rate.Univariate analysis and multivariate Logistic regression analysis were used to identify the risk factors for AR in patients with LAA cerebral infarction.Results Among the 308 patients with LAA cerebral infarction,74 cases(24.0%)had AR and 234 had AS.The univariate analysis showed that the proportion of patients with diabetes history and fibrinogen and D-dimer levels were significantly higher in the AR group than in the AS group(χ^(2)=4.147,t=2.529,U=5470.500,P<0.05).The multivariate Logistic regression analysis showed that diabetes history and high D-dimer level were independent risk factors for AR.Conclusion Diabetes history and high D-dimer level constitute independent risk factors for AR,which help with the early identification of high-risk population of AR.