脑梗死二级预防中阿司匹林抵抗及其与血管事件的关系

目的 探讨脑梗死二级预防中阿司匹林抵抗(AR)发生率.随访期AR与脑梗死复发及其他血管事件发生的关系.方法 600例脑梗死患者,入院当Et开始服用阿司匹林,服用7～10 d后检测血小板聚集率,筛选出AR患者及敏感患者,并对患者进行6～24个月随访,观察脑梗死复发及其他血管事件发生情况,采用Logistic回归分析AR及血管事件发生的危险因素和预后.结果 600例脑梗死患者中有AR者150例(25.0%),敏感者450例(75.0%);AR组女性、糖尿病患者比例及血低密度脂蛋白(LDL)胆固醇水平均高于阿司匹林敏感组;糖尿病(OR=2.58,95% CI 1.37～4.85,P=0.003)、高LDL血症(OR=1.89,95% CI 1.21～2.93,P=0.005)为AR发生的独立危险因素;AR组随访期脑梗死复发率、心肌梗死发生率以及全因死亡率均高于阿司匹林敏感组;糖尿病(OR=2.47,95% CI 1.36～4.65,P=0.003)、动脉粥样硬化血栓型脑梗死(OR=2.13,95% CI 1.24～3.95,P=0.023)及AR(OR=3.86,95% CI 1.79～5.87,P=0.002)是随访期血管事件发生的独立危险因素,有AR者血管事件发生的风险增加3.86倍.结论 脑梗死二级预防中AR发生率高,AR与脑梗死复发及其他血管事件的发生密切相关.

Aspirin resistance and vascular events in secondary prevention of cerebral infarction

Objective To investigate the incidence of the aspirin resistance in secondary prevention of cerebral infarction, and the relationship between the aspirin resistance and the cerebral infarction recurrence or other vascular events during the follow-up periods.Methods Aspirin were taken from the first day of admission in 600 patients with cerebral infarction.The platelet aggregation rate was measured after 7-10 days to screen the patients with aspirin resistance or aspirin sensitivity.All patients were followed up for 6 to 24 months and the cerebral infarction recurrence and other vascular events were recorded.Logistic regression model was used to estimate the risk factors of aspirin resistance, vascular events and prognosis.Results Of 600 patients, 150 (25.0% ) patients were resistant to aspirin and 450 (75.0% ) patients were sensitive to aspirin.The proportion of female and diabetes patients, and the level of low density lipoproteins (LDL) in the aspirin resistance group were higher than those in the aspirin sensitivity group.Diabetes (OR = 2.58, 95% CI 1.37-4.85, P=0.003) and high LDL level (OR = 1.89, 95% CI 1.21-2.93, P = 0.005 ) were independent risk factors of aspirin resistance.The incidence of cerebral infarction recurrence and myocardial infarction and all-cause mortality in the aspirin resistance group were all higher than those in the aspirin sensitivity group.Diabetes ( OR = 2.47, 95% CI 1.36-4.65, P = 0.003 ) , atherothrombosis cerebral infarction (OR = 2.13, 95% CI 1.24-3.95, P = 0.023) and aspirin resistance (OR = 3.86,95% CI 1.79-5.87, P = 0.002) were independent risk factors of vascular events during the following-up period.In the patients with aspirin resistance, the risk of the recurrence of vascular events increased 3.86 times.Conclusions The incidence of aspirin resistance is high in secondary prevention of cerebral infarction.Aspirin resistance is closely correlated with cerebral infarction recurrence and other vascular events.