急性脑梗死患者阿司匹林抵抗危险因素分析

目的探讨急性脑梗死患者阿司匹林抵抗（AR）现象及其影响因素。方法收集330例急性脑梗死患者，根据血栓弹力图测定花生四烯酸（AA）诱导途径的血小板抑制率。血小板抑制率≤20％即判定为AR，抑制率在20％-50％之间则判定为阿司匹林半抵抗（ASR），抑制率〉50％即为阿司匹林敏感（AS）。根据上述标准将患者进行分组，研究AR的发生率，并分析各组间各项临床特征的差异，采用Logistic回归分析影响AR与ASR的危险因素。结果330例急性脑梗死患者中AR发生率为33．9％，ASR发生率为19．7％。与As组相比，AR＋ASR组中高敏C反应蛋白（hs—CRP）水平明显升高（P〈0．05）。≥65岁患者中，高风险患者AR＋ASR发生率显著升高（P〈0．05）。Logistic回归分析表明血小板计数[OR=0．996，95％可信区间（CI）：0．991—0．999，P=0．041]和hs．CRP（OR=0．972，95％I：0．959—0．996，P=0．014）是发生AR与ASR的危险因素。结论急性脑梗死患者AR的发生率较可能与血小板数量和患者炎症状态有关。

Analysis on risk factors for aspirin resistance in patients with acute cerebral infarction

Objective To investigate the aspirin resistance （AR） and its risk factors in patients with acute cerebral infarction. Methods A total of 330 patients with acute cerebral infarction were enrolled. According to the platelet inhibition rate of arachidonic acid （AA） by thrombelastography, the patients were classified into AR group （platelet inhibition rate ≤ 20% ）, aspirin semi-resistance （ASR） group （ platelet inhibition rate 20% -50% ） and aspirin sensitivity （AS） group （platelet inhibition rate 〉 50% ）. The incidence rate of AR was analyzed, the difference of clinical characteristics was analyzed, and Logistic regression analysis was performed for the risk factors of AR and ASR. Results The 33.9% patients had AR, and 19.7% patients had ASR. The high sensitive C reactive protein （hsCRP） level in AR ＋ ASR group increased obviously compared with that in AS group（ P 〈 0.05 ）. In the patients older than 65 years old, the incidence rate of AR ＋ ASR in high risk patients increased significantly （ P 〈 0.05 ）. Logistic regression analysis showed that platelet counts [ odd ratio （OR） = 0.996,95 % confidence interval （CI） ： 0. 991-0. 999, P = 0.041 ] and hs-CRP levels （ OR = 0. 972,95 % CI： 0. 959-0. 996, P = 0.014 ） were risk factors for AR and ASR. Conclusions The incidence rate of AR in patients with acute cerebral infarction may be related to platelet count and inflammation.