服用小剂量阿司匹林患者的阿司匹林抵抗

目的 探讨服用小剂量阿司匹林患者的阿司匹林抵抗（AR）现象及其影响因素.方法 入选328例病情稳定的心脑血管病、糖尿病等患者,每日服用阿司匹林100 mg,连服14 d后,分别用花生四烯酸（AA）、二磷酸腺苷（ADP）作诱导剂检测血小板聚集率.满足AA诱导的血小板平均聚集率≥20%、ADP诱导的血小板平均聚集率≥70%两项者为AR;仅满足其中一项为阿司匹林半抵抗（ASR）;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 328例患者中AR发生率为4.9%,ASR发生率为27.4%.与AS相比,AR＋ASR中以女性、高龄、糖尿病及高血压病患者较多,吸烟者较少.Logistic回归分析表明,糖尿病[相对比值比（OR）=0.953,95%可信区间（CI）0.323～0.876,P=0.013]和高血压病（OR=0.610,95%CI 0.376～0.991,P=0.045）是发生AR与ASR的独立危险因素.不吸烟者发生AR与ASR的危险性升高（OR=2.231,95%CI 1.182～4.210,P=0.013）.结论 服用小剂量阿司匹林的患者中AR发生率为4.9%;发生AR与ASR可能与糖尿病、高血压等因素有关,不吸烟者发生AR与ASR的危险性升高.

Aspirin resistance in patients taking small dose of aspirin

OBJECTIVE: To investigate the phenomenon and influencing factors of aspirin resistance (AR) in patients taking small dose of aspirin. METHODS: Three hundred and twenty-eight patients with stable cardiac and cerebral vascular diseases, diabetes mellitus, et al taking aspirin 100 mg/d for > or =14 days, and then their blood samples were collected for determination of optical platelet aggregation index using arachidonic acid (AA) and adenosine diphosphate (ADP). AR was defined as a state in which aggregation of > or =20% with AA and that > or =70% with 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. The difference in clinical characteristics among the groups and independent risk factors associated with AR and ASR were analyzed. RESULTS: Of 328 patients, 4.9% were AR, 27.4% were ASR. Among AR+ASR group, female, elderly, diabetic and hypertensive patients were predominant, but less common in smokers. Logistic regression analysis showed that diabetes mellitus was an independent risk factor of AR and ASR [odds ratio (OR)=0.953, 95% confidence interval (CI) 0.323-0.876, P=0.013], and hypertension was independently associated with AR and ASR (OR=0.610, 95%CI 0.376-0.991, P=0.046). The risk of AR and ASR was increased in non-smokers (OR=2.231, 95%CI 1.182-4.210, P=0.013). CONCLUSION: The incidence rate of AR in patients taking small dose of aspirin was 4.9%. Diabetes mellitus and hypertension are relative risk factors of AR and ASR. The risk of AR and ASR in the no-smoking patients is increased.