血栓弹力图评价急性心肌梗死患者经皮冠状动脉介入术后阿司匹林抵抗及其影响因素

目的利用血栓弹力图(TEG)结果评价急性心肌梗死患者经皮冠状动脉介入(PCI)治疗后的阿司匹林抵抗(AR)发生率,并分析其影响因素,为患者个体化治疗提供依据。方法选取2014年来我院就诊的急性心肌梗死PCI术后患者170例,收集并分析患者的临床资料及其TEG结果,根据TEG检测花生四烯酸抑制率(AA抑制率)分为阿司匹林敏感组(105例)及AR组(65例),对两组患者的临床资料进行单因素及多因素logistic回归分析。结果 170例患者AR发生率为38.2%(65/170),AR组和阿司匹林敏感组AA抑制率分别为(32.14±12.77)%和(74.48±16.19)%。两组患者长期吸烟史、高脂血症病史比较,差异具有统计学意义(P0.05),性别、年龄、长期饮酒史、糖尿病病史、高血压病史、心律失常病史及血常规、生化指标、TEG各参数比较,差异均无统计学意义(P0.05)。多因素logistic回归分析结果显示,长期吸烟为AR的影响因素。结论长期吸烟可能是急性心肌梗死行PCI术后发生AR的危险因素。     

阿司匹林抵抗

自20世纪70年代起,阿司匹林作为抗血小板药物广泛用于心血管疾病的预防和治疗,大量循证医学证据证实心脑血管疾病高危患者应用阿司匹林,可使心脑血管事件如心肌梗死、脑卒中降低25%。但是,近年研究发现仍有部分服用阿司匹林的患者不能充分抑制血小板功能而致临床血栓事件的发生     

阿司匹林抵抗

阿司匹林对心脑血管病缺血事件的预防作用已得到广泛认可,但服用治疗剂量的阿司匹林并不能对所有个体产生有效的预防作用,因此有学者提出了阿司匹林抵抗的概念,但目前还存在许多不同观点。     

OPCABG术后阿司匹林抵抗的观察

目的 探讨非体外循环冠状动脉搭桥术(OPCABG)后阿司匹林抵抗(AR)规律.方法 应用流式细胞技术,检测56例OPCABG患者血小板膜表面活化标记物CD62P及PAC-1的表达情况.结果 术前口服阿司匹林后CD62P、PAC-1阳性表达率分别为6.04%±5.80%、13.63%±12.70%;术后1 d分别为10.20%±3.40%、15.45%±9.40%,均明显降低(P＜0.05);术后5 d分别为21.02%±16.52%、39.24%±11.53%,与术后1 d相比均明显升高(P＜0.05);术后10 d分别为5.65%±1.12%、16.01%±5.43%,与术前口服阿司匹林后相比,P＞0.05.结论 OPCABG后存在一过性AR.     

冠心病阿司匹林抵抗的研究与对策

阿司匹林是冠心病患者长期抗血小板治疗的基石, 同其他抗血小板药物一样, 阿司匹林也存在抗血小板药物 抵抗现象, 若发生阿司匹林抵抗, 可能会增加冠心病患者心血管事件风险。目前已有多项研究对抗血小板药物抵抗 进行了探究, 文章针对阿司匹林抵抗的定义、相关机制、实验室检测、临床影响及可能有效的治疗干预措施等研究进 展进行概述, 旨在提高临床医生对阿司匹林抵抗的认识, 并科学优化冠心病患者的抗血小板治疗。     

低剂量阿司匹林治疗时糖尿病对阿司匹林抵抗的影响

冠心病死亡通常是由于血小板黏附形成血栓，从而限制冠状动脉血流引发心脏病发作导致的。应用阿司匹林可通过抑制血小板聚集而降低心脏病发作的危险，尤其是通过阻断重要的酶-COX-1。然而，最近的研究提示一些糖尿病患者对阿司匹林这种重要作用的反应可能会小一些。目前，还没有前瞻性的研究比较在糖尿病和非糖尿病患者中阿司匹林剂量对血小板抑制作用的不同。来自Maryland的Sinai医院血栓研究中心的学者研究了120例稳定型冠心病的患者（其中30例患糖尿病），他们被随机分组，     

血清FABP3水平与冠状动脉病变及阿司匹林抵抗的关系

目的:测定冠心病患者血清脂肪酸结合蛋白3(fatty acid binding protein 3,FABP3)水平,探讨FABP3与冠心病患者冠状动脉(冠脉)病变严重程度及阿司匹林抵抗的关系。方法:选取2017-06-2017-12成都军区总医院心内科住院部患者80例,其中冠心病患者43例和对照组患者37例,根据病变支数分为单支病变、多支病变组;根据阿司匹林抵抗标准将冠心病患者分为阿司匹林敏感组和阿司匹林非敏感组。根据采用液相蛋白芯片检测血清FABP3水平,同时检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂各项指标。结果:冠心病组血清FABP3水平高于对照组,多支病变组较单支病变组FABP3水平升高(P0.05)。阿司匹林敏感组血清FABP3水平显著高于阿司匹林非敏感组(P0.01)。结论:血清FABP3水平一定程度上可反映冠脉病变严重程度。冠心病患者阿司匹林抵抗发生与FABP3水平密切相关。     

通心络胶囊对冠心病病人阿司匹林抵抗的影响

目的观察通心络胶囊对冠心病病人阿司匹林抵抗（AR）的影响.方法选择冠心病并AR病人64例,分为联合治疗组（32例）及通心络组（32例）.联合治疗组予通心络胶囊与阿司匹林联合使用,通心络组则停用阿司匹林片两周后服用通心络胶囊.结果通心络组治疗总有效率为50.0%,联合治疗组总有效率为90.6%;两组血小板聚集率均明显降低.随诊9个月,均无严重急性心血管事件的发生,无并发症发生.结论对冠心病AR病人,通心络有较好效果,与阿司匹林联用效果更明显.     

阿司匹林抵抗的研究进展

近年研究发现,一些个体规律服用适当剂量的阿司匹林,仍不能免除缺血性事件的发生,其机制可能与环氧化酶-2、单核苷酸多态性或变异等有关。     

阿司匹林抵抗

研究表明在接受阿司匹林治疗的心血管疾病患者中有5%～45%存在阿司匹林抵抗,由于全球有大量的患者依赖阿司匹林的抗血小板治疗,所以关于阿司匹林抵抗的研究已经引起广泛关注.本文综述阿司匹林抵抗的可能机制.     

Prevalence of and risk factors for aspirin resistance in elderly patients with coronary artery disease

Objective To assess the prevalence of and related risk factors for aspirin resistance in elderly patients with coronary artery disease (CAD). Methods Two hundred and forty-six elderly patients (75.9 ± 7.4 years) with CAD who received daily aspirin therapy (≥ 75 mg) over one month were recruited. The effect of aspirin was assessed using light transmission aggregometry (LTA) and thrombelastography platelet mapping assay (TEG). Aspirin resistance was defined as ≥ 20% arachidonic acid (AA)-induced aggregation and ≥ 70% adenosine diphosphate (ADP)-induced aggregation in the LTA assay. An aspirin semi-responder was defined as meeting one (but not both) of the criteria described above. Based on the results of TEG, aspirin resistance was defined as ≥ 50% aggregation induced by AA. Results As determined by LTA, 23 (9.3%) of the elderly CAD patients were resistant to aspirin therapy; 91 (37.0%) were semi-responders. As determined by TEG, 61 patients (24.8%) were aspirin resistant. Of the 61 patients who were aspirin resistant by TEG, 19 were aspirin resistant according to LTA results. Twenty-four of 91 semi-responders by LTA were aspirin resistant by TEG. Multivariate logistic regression analysis revealed that elevated fasting serum glucose level (Odds ratio: 1.517; 95% CI: 1.176–1.957; P = 0.001) was a significant risk factor for aspirin resistance as determined by TEG. Conclusions A significant number of elderly patients with CAD are resistant to aspirin therapy. Fasting blood glucose level is closely associated with aspirin resistance in elderly CAD patients.     

Low-dose aspirin increases aspirin resistance in patients with coronary artery disease

PURPOSE: We sought to investigate the association of aspirin dose and aspirin resistance in stable coronary artery disease patients measured by a point-of-care assay. METHODS: We studied 468 consecutive stable coronary artery disease patients in a referral cardiac center who were taking aspirin 80 to 325 mg daily for > or =4 weeks. The VerifyNow Aspirin (Ultegra RPFA-ASA, Accumetrics Inc, San Diego, Calif) was used to determine aspirin responsiveness. An aspirin reaction unit (ARU) > or =550 indicates the absence of aspirin-induced platelet dysfunction, based on correlation with epinephrine-induced light transmission aggregometry. Demographic and clinical data were collected to analyze the predictors of aspirin resistance. RESULTS: Aspirin resistance was noted in 128 (27.4%) patients. Univariate predictors of aspirin resistance include elderly (P = 0.002), women (P <0.001), anemia (P <0.001), renal insufficiency (P = 0.009) and aspirin dose < or =100 mg (P = 0.004). Multivariate analysis revealed hemoglobin (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.51 to 0.69; P <0.001) and aspirin dose < or =100 mg (OR 2.23; 95% CI 1.12 to 4.44; P = 0.022) to be independent predictors of aspirin resistance. Daily aspirin dose < or = 100 mg was associated with increased prevalence of aspirin resistance compared with 150 mg and 300 mg daily (30.2% vs 16.7% vs 0%, P = 0.0062). CONCLUSION: A 100 mg or less daily dose of aspirin, which may have lower side effects, is associated with a higher incidence of aspirin resistance in patients with coronary artery disease. Prospective randomized studies are warranted to elucidate the optimal aspirin dosage for preventing ischemic complications of atherothrombotic disease.     

冠心病患者C反应蛋白的临床意义及阿司匹林的影响

目的 :探讨 C反应蛋白 (CRP)与冠心病 (CHD)的关系及阿司匹林对其的影响。方法 :观察 6 9例冠状动脉单支狭窄 >6 0 %的 CHD患者 ,35例正常对照者及 31例病例对照者的 CRP浓度及不同剂量的阿司匹林对CRP浓度的影响 ,及 CRP浓度的高低与冠状动脉狭窄程度的关系。结果 :CHD患者的 CRP浓度较正常对照组显著增高 (P <0 .0 5 ) ,大剂量的阿司匹林可降低 CHD患者的 CRP浓度 (P <0 .0 5 ) ,CRP浓度与冠状动脉狭窄程度正相关 (r =0 .5 3,P <0 .0 5 )。结论 :CRP浓度可作为评价冠状动脉病变严重程度的一个参考指标     

阿托伐他汀及阿司匹林对冠心病患者C-反应蛋白的影响

目的 探讨阿托伐他汀及阿司匹林时冠心病患者C-反应蛋白的影响。方法观察109例冠心病患者的C-反应蛋白在用药前后的变化。其中阿托伐他汀组37例，阿司匹林组29例，阿托伐他汀和阿司匹林联用组43例。结果3组患抒用药前后C-反应蛋白的改变差异均有统计学意义（P〈O.05），而阿托伐他汀及阿司匹林联用组用药后C-反应蛋白的浓度与另两组用药后C-反应蛋白的浓度比较差异办有统计学意义（P〈O.01）。结论阿托伐他汀和阿司匹林联刚对C-反应蛋白的降低优于单一的阿托伐他汀或阿司匹林。     

老年冠心病患者阿司匹林抵抗的临床研究

目的：探讨老年冠心病患者阿可匹林抵抗（AR）的发生率及其临床特征,评价AR的相关危险因素。方法：对135例患老年冠心病,口服阿司匹林≥100mg超过7d的患者,采用血小板聚集仪分别测定花生四烯酸、二磷酸腺苷（ADP）诱导的血小板聚集率（PAR）。AR的定义：用0．5mmol／L花生四烯酸诱导,平均PAR≥20％,用10μmol／L的ADP诱导,平均PAR≥70％。阿司匹林半抵抗（ASR）即符合上述AR两条件之一者,均不满足者为阿司匹林敏感（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的独立危险因素。结果：AR、ASR及AS发生率分别为13．3%（18／135）、28．9％（39／135）及57．8％（78／135）。与AS者相比,AR组中糖尿病患者明显增多,且该组患者纤维蛋白原（Fb）水平明显高于AS组[（4．21±1．09）g／L：（3．58±0．80）g／L,P〈0．05]。Logistic回归分析表明,糖尿病[相对比值比（OR）=7．402,95％可信区间（CI）3．110～17．620,P〈0．01]是发生AR与ASR的独立危险因素。结论：研究人群中阿司匹林抵抗的发生率为13．3％,发生AR与ASR可能与糖尿病有关,高Fb患者发生AR的危险性升高。     

Determinants of aspirin resistance in patients with type 2 diabetes

BackgroundCardiovascular disease is a leading cause of mortality among patients with type 2 diabetes mellitus (T2DM). Numerous patients with T2DM show resistance to aspirin treatment, which may explain the higher rate of major adverse cardiovascular events observed compared with non-diabetes patients, and it has recently been shown that aspirin resistance is mainly related to accelerated platelet turnover with persistent high platelet reactivity (HPR) 24 h after last aspirin intake. The mechanism behind HPR is unknown. The aim of this study was to investigate the precise rate and mechanisms associated with HPR in a population of T2DM patients treated with aspirin.MethodsIncluded were 116 consecutive stable T2DM patients who had attended our hospital for their yearly check-up. HPR was assessed 24 h after aspirin intake using light transmission aggregometry (LTA) with arachidonic acid (AA) and serum thromboxane B2 (TXB2) measurement. Its relationship with diabetes status, insulin resistance, inflammatory markers and coronary artery disease (CAD) severity, using calcium scores, were investigated.ResultsUsing LTA, HPR was found in 27 (23%) patients. There was no significant difference in mean age, gender ratio or cardiovascular risk factors in patients with or without HPR. HPR was significantly related to duration of diabetes and higher fasting glucose levels (but not consistently with HbA_1c), and strongly related to all markers of insulin resistance, especially waist circumference, HOMA-IR, QUICKI and leptin. There was no association between HPR and thrombopoietin or inflammatory markers (IL-6, IL-10, indoleamine 2,3-dioxygenase activity, TNF-α, C-reactive protein), whereas HPR was associated with more severe CAD. Similar results were found with TXB2.ConclusionOur results reveal that ‘aspirin resistance’ is frequently found in T2DM, and is strongly related to insulin resistance and severity of CAD, but weakly related to HbA_1c and not at all to inflammatory parameters. This may help to identify those T2DM patients who might benefit from alternative antiplatelet treatments such as twice-daily aspirin and thienopyridines.     

联合治疗对冠脉综合征患者阿司匹林抵抗的疗效

目的：探讨联合治疗对冠脉综合征（ACS）患者阿司匹林抵抗（AR）的疗效。方法：168例有AR的ACS患者随机被分为三组：一组为对照组（阿司匹林剂量维持不变），一组为阿斯匹林加量组，一组为联合治疗组（在阿司匹林基础上加服双嘧达莫）。于入院时及两周后分别检查血小板聚集率、尿11-脱氢-血栓素（11-DH—TxB2）等项指标。结果：上述三组于入院当日上述两项指标，均高于正常值。至二周后阿斯匹林加量组有下降趋势．但无显著性差异（P〉0．05）；联合治疗组上述两项指标均明显下降，与对照组相比有显著差异（P〈0．05）。结论：在阿司匹林的基础上联合双嘧达莫，能更有效地降低急性冠脉综合征患者的阿司匹林抵抗。     

老年冠心病患者冠状动脉内支架术的疗效研究

目的：探讨老年冠心病患冠状动脉内支架术的近期疗效和对远期预后的影响。方法：2000年6月-2002年6月连续240例冠心病患行选择性冠状动脉内支架术，其中86例年龄＞65岁(A组)，154例＜65岁(B组)，比较两组支架术成功率及远期随访结果。结果：A组中84例支架术成功(97．7％)，并发症率9．30％。B组中150例支架术成功(97．4％)，并发症率4．55％，两组差异均无显性(P＞0．05)。随访12．5土6．5个月，随访率95．7％。A、B两组的心功能改善(54．7％和51．9％)、心绞痛复发(30．2％和36．4％)、再入院(18．6％和20．1％)、总心脏事件发生率(18．6％和22．7％)及无心脏事件存活率(86．0％和85．1％)均无显性差异(P＞0．05)。结论：老年患冠状动脉内支架术安全、成功率高，且远期预后良好。     

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。     

氯吡格雷抵抗和冠心病患者PCI术后心血管事件的关系

目的：前瞻性研究氯吡格雷抵抗对冠心病患者发生近、中期心血管事件的影响。方法：102例冠心病患者在服用氯吡格雷前及服药后4天取血，利用比浊法测定血小板聚集率（PAR），计算PAR基线值与服药后最大血小板聚集率（MPAR）差值，其差值≤10％为发生氯吡格雷抵抗，氯吡格雷抵抗组24例，非氯吡格雷抵抗组78例。患者住院期间及出院后随访2～12，平均（7．57士2．91）个月，COX回归分析氯吡格雷抵抗对103例冠心病介入治疗后患者近、中期心血管事件的影响。结果：氯吡格雷抵抗组心血管事件的发生率为58．3％，显著高于非抵抗组（16．7％），P〈0．001。COX回归分析发现，氯吡格雷抵抗（RR=70．262，95％CI=0．123～0．558，P=0．001）和冠脉病变程度（RR=1．052，95％CI=1．030～1．075，P〈0．001）是冠心病患者PCI术后近、中期发生心血管事件的独立危险因素。结论：氯吡格雷抵抗、冠脉病变程度重的患者容易于PCI术后近、中期发生心血管事件。