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。

Morbidity rate and clinical feature of aspirin resistance and its risk factors in elderly patients with coronary artery disease

Objective： To study the morbidity rate and clinical feature of aspirin resitance （AR） and its risk factors in elderly patients with coronary artery disease （CAD） . Methods： A total of 135 elderly CAD patients took aspirin 100mg/d for 1 week. The platelet aggregation induced from adenosine diphosphate （ADP） and arachidonic acid （AA） was used to evaluate AR. AR was defined as a state in which aggregation of ≥20% with AA and that ≥70% with ADP was found. Aspirin semi-resistance （ASR） was defined as meeting one of the above criteria. If the above criteria were not met, the condition was defined as aspirin sensitive （AS）. The difference in clinical characteristics among above three groups and independent risk factors associated with AR and ASR were analyzed. Results： The 13.3% patients showed AR, 28.9% showed ASR, 57.8 % showed AS. Among AR, the diabetic patients were predominant. The fibrinogen level of AR was significantly higher than that of AS patients [ （4.21±1.09） g/L vs. （3.58±0.80） g/L, P〈0.05]. Logistic regression analysis showed that diabetes mellitus was an independent risk factor of AR and ASR （OR=7. 402, 95% CI 3. 110-17. 620, P〈0.01）. Conclusion： The aspirin resistance accounts for 13.3% of elderly CAD patients. The diabetes mellitus is relative risk factor of AR and ASR. The risk of AR and ASR increase in patients with high level of fibrinogen.