冠心病患者阿司匹林抵抗及其影响因素

目的探讨冠心病患者阿司匹林抵抗（Aspirin resistance,AR）现象及其影响因素。方法入选1 731例入院诊断为冠心病（急性冠状动脉综合征和稳定型心绞痛）的患者。采用血小板聚集仪分别测定花生四烯酸（AA）、腺苷二磷酸（二磷酸腺苷,ADP）诱导的血小板聚集率。AR定义为0.5 mmol/L花生四烯酸时血小板平均聚集率≥20%,用10μmol/L ADP时血小板平均聚集率≥70%。阿司匹林半抵抗（Aspirin semiresistance,ASR）即符合上述两个条件之一者。均不符合者为阿司匹林敏感（Aspirin sensitive,AS）。用统计学方法分析各组间各项临床特征差异及影响AR与ASR的危险因素。结果1 731例患者中AR的发生率3.58%（62/1 731）,ASR的发生率20.34%（352/1 731）。与AS相比,AR＋ASR中以女性、高龄、高脂血症患者较多,吸烟者较少。而且AS患者的血小板计数偏高,总胆固醇水平偏低。Logistic回归分析表明,女性[相对比值比（OR）=1.377,95%可信区间（CI）1.084～1.751,P=0.009〗、老年（OR=1.504,95%CI1.005～2.253,P=0.047）、总胆固醇（TCHO）（OR=1.249,95%CI1.114～1.401,P=0.000）升高是发生AR与ASR的危险因素。结论服用阿司匹林的冠心病患者中AR发生率为3.58%,ASR发生率为20.34%。发生AR与ASR危险因素有女性、高龄、高血脂。

Prevalence and influential factors of aspirin resistance in patients with coronary artery disease

Objective To investigate the prevalence and influential factors of aspirin resistance in patients with coronary artery disease.Methods A total of 1731 patients with coronary artery diseases were evaluated for aspirin resistance with detection of optical platelet aggregation induced by arachidonic acid（AA）and adenosine diphosphate（ADP）.Aspirin resistance（AR）was defined as a state in which aggregation of over 20% with 0.5 mmol/L AA and that over 70% with 10 μmol/L ADP was found.Aspirin semiresistance（ASR） was defined as meeting one of the above criteria.If both above criteria were not met,the condition was defined as aspirin sensitive（AS）.The prevalence of AR among the study population and the influential factors associated with AR and ASR were analyzed.Results A 3.58% of the patients were AR and 20.34% were ASR.Among the AR＋ASR group,female,elderly and hyperlipidemia patients were predominant,but less common in smokers.The platelet count and Cholesterol level were higher in the AR group than in the AS group.Logistic regression analysis showed that the risk of AR and ASR was female [odds ratio（OR）=1.377,95% confidence interval（CI） 1.084-1.751,P=0.009] and elderly（OR=1.504,95% CI 1.005-2.253,P=0.047）.AR and ASR were more frequent in patients with hypercholesterolemia or thrombocytosis.Conclusion The risk factors of AR and ASR were female,elderly and hyperlipidemia.