不同剂量阿司匹林对急性冠状动脉综合征炎性标志物和预后的影响

目的 观察不同剂量阿司匹林对急性冠状动脉综合征(ACS)患者炎性标志物和临床预后的影响.方法 将ACS患者随机分为不同剂苗阿司匹林治疗组(A组100 mg/d、B组500 mg/d和C组1000 mg/d)治疗和随访1年,检测各时段炎性标志物水平,并记录有关临床事件.结果 共入选312例,A组106例,B组104例,C组102例.所有入选者基线超敏C反应蛋白(hsCRP)、IL-6、TNFα均显著高于正常参考值,应用不同剂量阿司匹林治疗1、6、12个月后,炎性标志物均下降,治疗前后各指标比较差异均有统计学意义,但各组间比较差异无统计学意义.3组急性冠状动脉事件发生率差异无统计学意义,B、C组发生胃肠道不适症状者较A组增加.结论 ACS患者血清炎性标志物升高,应用阿司匹林治疗后炎性标志物水平显著下降,但大剂量阿司匹林(500～1000 mg)未见炎性标志物水平进一步下降和再发心脏事件减少,而胃肠道不良反应有所增加.

The effect of different dosage of aspirin on inflammatory biomarkers and prognosis in acute coronary syndrome

Objective To observe and assess the effect of different dosages of aspirin on inflammatory biomarkers, hemorheology (platelet aggregation rate) and clinical prognosis in patients with acute coronary syndrome ( ACS). Methods ACS patients were randomly assigned to receive different dosages of aspirin treatment orally. Patients in group A,B and C took 100 mg, 500 mg and 1000 mg of aspirin per day respectively. They were treated and followed-up for 1 year. High-sensitivity C-reactive protein ( hsCRP) , IL-6, tumor necrosis TNFot and platelet aggregation rate were examined and major adverse cardiac events( MACE) were recorded. Results A total of 312 patients with ACS were enrolled in the study. The baseline characteristics of the three groups were not different with respect to age, gender, cardiovascular risk profile, level of inflammatory biomarkers and concomitant treatment before and after randomization. The levels of baseline serum hsCRP, IL-6 and TNFa were higher in subjects of the study as compared with normal reference value (P<0. 05, <0. 05, <0. 01) and they decreased significantly after therapy with 3 different doses of aspirin (detected at 30 days, 6 months and 12 months, P <0. 001 ) , but there were no significant differences among the three groups( P >0. 05) . Rehospitalization , MACE and the change of platelet aggregation ratio were not significantly different among the three groups. The incidence of gastrointestinal complaints was significantly higher in groups B and C than in group A ( P < 0. 05 ). Conclusions The levels of serum inflammatory biomarker increase in patients with ACS. Aspirin therapy may decrease the level of inflammatory markers significantly, but increasing the dosage of aspirin from 100 mg to 1000 mg daily does not decrease the level of inflammatory markers and the clinical MACEs further. However, the incidence of gastrointestinal complaints increase significantly with the increase of aspirin dosage.