急性缺血性脑卒中患者的阿司匹林抵抗与预后的相关性

目的:探讨急性缺血性脑卒中患者中阿司匹林抵抗(AR)的发生率及其与预后的关系。方法:连续入选212例急性缺血性脑卒中患者,入院当天开始服用阿司匹林,7¹0 d后检测血小板聚集率,筛选出AR患者(AR组)及阿司匹林敏感AS患者(AS组),并进行310 d后检测血小板聚集率,筛选出AR患者(AR组)及阿司匹林敏感AS患者(AS组),并进行3²4个月随访,观察随访期间缺血性卒中的再发以及死亡情况,采用Logistic回归分析AR发生的危险因素及其与死亡率的关系。结果:AR 68例(32.1%),AS144例(67.9%);2组一般资料差异无统计学意义;AR组发生缺血性卒中14例(20.6%),全因死亡22例(32.4%);AS组缺血性卒中19例(13.2%),全因死亡24例(16.7%);AR组死亡率高于AS组,差异有统计学意义(P=0.010),缺血性卒中复发率差异无统计学意义。AR(P=0.027)、NIHSS得分(P=0.003)及年龄(P=0.029)是急性缺血性卒中患者2年死亡率的独立危险因素。结论:急性缺血性卒中患者中AR发生率高,AR与急性缺血性卒中患者2年死亡率密切相关。

Correlation of Aspirin Resistance and Prognosis in Patients with Acute Ischemic Stroke

Objective： To investigate the correlation of aspirin resistance （AR） with prognosis in patients with a- cute ischemic stroke. Methods： Two hundred and twelve patients with acute ischemic stroke were consecutively selected, and aspirin was given from the first day of admission. 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 3 to 24 months and the ischemic stroke recurrence and related death events were recorded. Logistic regression mod- el was used to estimate the risk factors of aspirin resistance and the correlation between aspirin resistance and 2-year mortality. Results out of 212 patients, 68 （32.1%） patients were resistant to aspirin whereas 144 （67.9 %） patients were sensitive. There was no significant difference between the two groups in general, risk factors, labo- ratory test results and NIHSS scores （P〉0.05）. The incidence of all-cause mortality in aspirin resistance group was significant higher than that in aspirin sensitivity group （P=-0.01）. Logistic regression analysis revealed that the re- currence rate ofischemic stroke （20.6%） of was higher in AR group than that in AS group, but the difference was not significant （P〉0.05）. Aspirin resistance （OR=3.051,95% CI 1.072-7.895,P=-0.027）, NIHSS scores （OR=I. 208,95% CI 1.016-1.439,P=-0.003）, and age （OR=1.143,95% CI 1.078-1.202,P=-0.029） were independent risk predictors of 2-year mortality in patients with acute ischemic stroke. Conclusion： The incidence of aspirin resis- tance is high in patients with acute ischemic stroke. Aspirin resistance is closely correlated with 2-year mortality in patients with acute ischemic stroke.