服用阿司匹林急性脑梗死患者血小板参数变化及与阿司匹林抵抗的关系研究

Relationship between platelet parameters and aspirin resistance in acute cerebral infarction patients treated with aspirin

目的探究服用阿司匹林患者血小板参数变化及血小板参数与阿司匹林抵抗的相关性。方法选择98例急性脑梗死患者为研究对象,将其分为A组与B组。A组患者接受7 d阿司匹林治疗,B组患者不接受阿司匹林治疗,对比A、B 2组患者治疗前后血小板活化标志物P-选择素(CD62P)、PAC-1表达率。使用血栓弹力图检测将98例脑梗死患者分为阿司匹林抵抗组(AR组,n=36)、阿司匹林半抵抗组(ASR组,n=32)、阿司匹林敏感组(AS组,n=30),另选取同期进行体格检查的30例健康者为对照组,对比4组的血小板(PLT)计数、PLT平均体积(MPV)、PLT分布宽度(PDW)、PLT压积(PCT),并就血小板参数与阿司匹林抵抗性关系进行探究。结果治疗前A、B 2组患者CD62P及PAC-1表达率对比差异无统计学意义(P>0.05),治疗后A组患者上述指标表达率低于B组(P<0.05);AR组、ASR组及AS组PLT计数明显高于对照组(P<0.05),AR组及ASR组MPV明显高于AS及对照组(P<0.05),PDW、PCT组间比较差异无统计学意义(P>0.05);阿司匹林抵抗与患者PLT参数中的PLT计数及MPV呈正相关性(r=0.367、0.681,P<0.05)。结论服用阿司匹林急性脑梗死患者其PLT及MPV值越高,患者阿司匹林抵抗现象越明显,临床用药前应对患者进行相应检查,以便积极调整用药方案。

Objective To explore the changes of platelet parameters and the correlation between platelet parameters and aspirin resistance in acute cerebral infarction patients taking aspirin.Methods 98 patients with acute cerebral infarction were divided into group A and group B according to the method of random number table.Patients in group A received aspirin treatment for 7 days and patients in group B did not receive aspirin treatment.The platelet activation markers before and after treatment were compared between group A and group B.The expressions of P-selectin(CD62 P)and PAC-1 were detected by thromboelastography.98 patients with cerebral infarction were divided into aspirin resistance group(AR group,n=36),aspirin semi-resistance group(ASR group,n=32),aspirin sensitivity group(AS group,n=30)by thromboelastography.Another 30 healthy individuals underwent physical examination at the same time were selected as the control group.The platelet count,average volume of PLT(MPV),PLT distribution width(PDW)and PLT hematocrit(PCT)were compared among the four groups,and the relationship between platelet parameters and aspirin resistance was explored.Results There was no significant difference in the expression of CD62 P and PAC-1 between the A and B group before treatment(P>0.05).But the expression rate of the these indexes in group A was lower than that in group B after treatment(P<0.05).The PLT counts in AR,ASR and AS groups was significantly higher than that in AS and control group(P<0.05).There was no significant difference between PDW and PCT groups(P>0.05).There was a significant positive correlation between aspirin resistance and PLT count and MPV in PLT parameters(r=0.367、0.681,P<0.05).Conclusion The higher the value of PLT and MPV in patients with acute cerebral infarction taking aspirin,the more obvious the aspirin resistance in patients.