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目的:探讨我国患病人群中阿司匹林抵抗(aspirin resistance,AR)现象,比较不同AR实验检测法对阿司匹林疗效的判断及其临床应用价值。方法:对264例口服阿司匹林的患者(高血压、糖尿病等)分别进行光学法血小板聚集率(platelet aggregation test,PagT)、血栓弹力图(thrombelastography,TEG)、血和尿11-脱氢-血栓素B2(11-dehydro thromboxane B2,11-DH-TXB2)及P-选择蛋白表达检测,并对比分析患者的AR发生率、相关危险因素及AR与临床终点事件间的相关性。结果:口服阿司匹林患者采用各种方法检测到的AR发生率基本一致(P>0.05)。糖尿病患者AR和阿司匹林半抵抗(aspirin semi-resistance,ASR)的检出率有高于其他疾病组的趋势。低密度脂蛋白和空腹血糖的升高是AR的危险因素。几种检测方法的结果间有一定相关性(r为0.408～0.709,P<0.01)。以P-选择蛋白阳性为标准,TEG较其他检测方法有更高的灵敏度(89.29%)和特异度(92.31%),且与P-选择蛋白阳性间的一致性更高(K值为0.904,P<0.001)。结论:低密度脂蛋白升高和空腹血糖升高是AR发生的危险因素,TEG血小板图对AR检出的灵敏度较高,与P-选择蛋白检测结果间的一致性较高。
Objective: To investigate the phenomenon of aspirin resistance (AR) in the Chinese population and to compare the therapeutic effect of aspirin with different AR test methods and its clinical value. Methods: 264 patients with oral aspirin (hypertension, diabetes, etc.) were respectively subjected to optical platelet aggregation test (PagT), thrombelastography (TEG), blood and urine 11-dehydro-thromboxane B2 (11-dehydro thromboxane B2,11-DH-TXB2) and P-selectin expression were analyzed. The AR incidence, risk factors and the correlation between AR and clinical end point were analyzed. Results: The incidence of AR detected by various methods in patients with oral aspirin was basically the same (P> 0.05). The prevalence of AR and aspirin semi-resistance (ASR) in diabetic patients was higher than that in other disease groups. Low-density lipoprotein and fasting blood glucose is a risk factor for AR. There was some correlation between the results of several test methods (r = 0.408-0.709, P <0.01). TEG was more sensitive (89.29%) and more specific (92.31%) than other methods, and had a higher identity with P-selectin (K = 0.904, P <0.001). CONCLUSION: Elevated LDL and fasting plasma glucose levels are risk factors for AR. TEG platelet mapping is more sensitive to AR detection and more consistent with P-selectin test results.