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目的探讨急性脑梗死患者阿司匹林抵抗(AR)的发生与复发缺血性血管事件风险的关系。方法选择2013年7月~2014年6月在北京大学深圳医院神经内科住院的急性脑梗死患者110例,其中男64例,女56例;年龄40~82岁,平均年龄(64.7±12.1)岁。患者口服阿司匹林肠溶片7~10 d后采集外周静脉血,运用全血阻抗法测定血小板聚集程度,0.5 mmol/L花生四烯酸诱导的血小板聚集程度大于0欧姆即定义为AR,根据上述标准将患者分为AR及AS(aspirin sensitive,AS)组,对患者进行为期6个月的随访,终点事件包括短暂性脑缺血发作(TIA)、脑梗死、心肌梗死、死亡。结果 110例患者中31例患者为AR,AR的发生率为28.2%;AR组2型糖尿病患者的比例大于AS组(P<0.05);AR组复发缺血性血管事件的发生率大于AS组(22.6%vs 7.9%,P<0.05)。多元Logistic回归分析显示,AR是急性脑梗死患者缺血性血管事件复发的独立危险因素(OR=4.091,95%CI=0.024~0.946,P<0.05)。结论脑梗死患者存在一定比例的AR;2型糖尿病可能是AR发生的危险因素;AR可增加急性脑梗死患者复发缺血性血管事件的风险。
Objective To investigate the relationship between the occurrence of aspirin resistance (AR) and the risk of recurrent ischemic vascular events in patients with acute cerebral infarction. Methods A total of 110 acute cerebral infarction patients were hospitalized in Department of Neurology, Peking University Shenzhen Hospital from July 2013 to June 2014. There were 64 males and 56 females with a mean age of 64.7 ± 12.1 years . Patients taking aspirin enteric-coated tablets 7 to 10 days after the collection of peripheral venous blood, the use of whole blood impedance assay platelet aggregation, 0.5 mmol / L arachidonic acid induced platelet aggregation greater than 0 ohms that is defined as AR, according to the above criteria The patients were divided into AR and AS (aspirin sensitive, AS) groups. The patients were followed up for 6 months. The end points included transient ischemic attack (TIA), cerebral infarction, myocardial infarction and death. Results Among the 110 patients, 31 patients were AR, the incidence rate of AR was 28.2%. The proportion of AR patients with type 2 diabetes mellitus was greater than that of AS patients (P <0.05). The incidence of recurrent ischemic vascular events in AR patients was greater than that of AS patients (22.6% vs 7.9%, P <0.05). Multiple logistic regression analysis showed that AR was an independent risk factor for recurrent ischemic vascular events in patients with acute cerebral infarction (OR = 4.091, 95% CI = 0.024-0.946, P <0.05). Conclusions There is a certain proportion of AR in patients with cerebral infarction. Type 2 diabetes may be a risk factor for AR. AR may increase the risk of recurrent ischemic vascular events in patients with acute cerebral infarction.