老年高血压患者血小板聚集功能测定及阿司匹林抵抗相关危险因素分析

摘要

目的 测定老年高血压患者血小板聚集功能,并探讨该人群中阿司匹林抵抗(AR)的发生率和相关危险因素.方法 采用比浊法,使用二磷酸腺苷( ADP)及花生四烯酸(AA)两种不同的诱导剂测定184例老年高血压患者(服用阿司匹林组n=91,不服药对照组n=93)和血压正常老年人(n=25)的血小板聚集率,同时测定服药组血浆血栓素(TXB2)含量.根据检测结果将服药组分为AR组、阿司匹林半抵抗(ASR)组和阿司匹林敏感(AS)组.分析各组间的临床资料,探讨与AR有关的危险因素.结果 (1)不服药对照组血小板聚集率较血压正常组增高[( PAgTAA:(47±15)％vs( 40±17)％,P＜0.05;PAgTADP:(69±8)％vs(63±6)％,P＜0.01];(2)服用阿司匹林组中AR发生率为14.29％(13/91),ASR发生率为28.57％(26/91),AR组和ASR组血浆TXB2浓度均显著高于AS组[(78±5) vs (52±8) ng/L,(64±10) vs (52±8)μg/L,P＜0.01],血TXB2浓度与PAgTAA及PAgTADP均呈显著的相关性(P＜0.01);(3) AR+ASR组糖尿病患者及吸烟患者较AS组增多(P＜0.05);Logistic回归分析显示,空腹血糖增高和低密度脂蛋白增高是AR的独立危险因素(P=0.002和P=0.044).结论 老年高血压患者血小板聚集率高于血压正常老年人.老年高血压患者血TXB2浓度与AR有相关性,亦可作为类似于血小板聚集率的另一种生化检测指标.空腹血糖增高及低密度脂蛋白增高为AR的危险因素.%Objective To detect the platelet aggregation in elderly patients with hypertension and to determine the frequency of aspirin resistance and its risk factors. Methods A total of 184 elderly patients with hypertension (91 cases in aspirin therapy group and 93 cases in non-aspirin group) and 25 normal controls were enrolled in the study. Platelet aggregation was determined by adenosine diphosphate (ADP) or arachidonic acid (AA) induction and the level of blood thromboxane B2 (TXB2) was determined by ELISA. According to the meassurements, the patients in aspirin therapy group were divided into three groups: aspirin resistance(AR) group, aspirin semiresponder (ASR) group and aspirin sensitivity(AS) group. Differences in clinical data were analyzed to find the related risk factors of AR. Results The platelet aggregation rate in non-aspirin group was higher than that in normal group[(PAgTAA: (47 ± 15)% vs (40 ± 17)%, P < 0.05; PAgTADP: (69 ± 8)% vs (63 ± 6)%, P < 0.01]. The incidence of AR and ASR was 14.29%(13/91)and 28.57%(26/91) in aspirin therapy group. The plasma TXB2 level was higher in both AR group and ASR group than in AS group [(78 ± 5) vs (52± 8)μg/L, (64 ± 10) vs (52 ± 8) μg/L, P < 0.01]. The plasma TXB2 level was positively correlated with PAgTAA and PAgTADP(P < 0.01). There were more diabetic patients and smokers in AR and ASR groups than in AS group(P < 0.05). Logistic regression analysis revealed that AR is likely correlated with increased levels of fasting blood-glucose and low density lipoprotein (P=0.002 and P=0.044). Conclusion Elderly patients with hypertension have higher platelet aggregation rate than normal controls. The plasma TXB2 level is positively correlated with AR and may be used as biochemical test marker like platelet aggregation. The increased levels of fasting blood glucose and plasma low density lipoprotein are independent risk factors for AR in elderly patients with hypertension.