急性缺血性卒中患者的阿司匹林抵抗与卒中严重程度和梗死体积的相关性

摘要

Objective To investigate whether aspirin resistance is associated with initial stroke severity and infarct volume using diffusion-weighted imaging (DWI) in patients with acute ischemic stroke that occurred while taking aspirin.Methods 350 patients admitted within 48 hours of acute ischemic stroke onset were selected as study objects.All patients had been taking aspirin for at least 7 days before stroke onset.Aspirin resistance,defined as high residual platelet reactivity (HPR) on aspirin treatment,was measured using PL assay and defined as MAR-AA more than 35％.Initial stroke severity was assessed using NIH Stroke Scale (NIHSS).Infarct volume was measured by DWI.Results HPR occurred in 93 patients (26.6％).The initial NIHSS score (median [interquartile range]) was higher in the aspirin resistant group than in the aspirin sensitive group (10 [4-15] vs.4 [2-6],P ＜ 0.001).DWI infarct volumes were also larger in the aspirin resistant group than in the aspirin sensitive group (5.3 [1.2-9.6] vs.1.8 [0.8-8.8],P ＜ 0.01).A multivariable median regression analysis showed that HPR was significantly associated with an increase of 6.0 points on NIHSS (95％ CI 3.68-8.31,P ＜ 0.001) and an increase of 2.8 cm3 in DWI infarct volume (95％ CI 0.6-6.2,P ＜ 0.01).Conclusions Aspirin resistance is associated with an increased risk of severe stroke and large infarct volume in patients taking aspirin before stroke onset.%目的 观察急性缺血性脑卒中患者阿司匹林抵抗与卒中严重程度及梗死灶体积的相关性.方法将发病48 h内且同时服用阿司匹林1周以上的350例急性缺血性卒中患者纳入本研究,应用PL-11血小板功能分析仪测定血小板反应性,阿司匹林抵抗即治疗后血小板高反应性(HPR)定义为花生四烯酸诱导血小板最大聚集率(MAR-AA)大于35％.梗死灶体积采用磁共振弥散加权成像(DWI)计算软件,卒中严重程度采用NIHSS评分.结果 HPR见于26.6％卒中患者;阿司匹林抵抗组初始NIHSS评分显著高于阿司匹林敏感组(10 [IQR 4～ 15]比4[IQR 2～6],P＜0.001);阿司匹林抵抗组梗死体积显著高于阿司匹林敏感组(5.3 [1.2 ～ 9.6]比1.8[0.8～8.8],P＜0.01);多变量中位数回归分析显示HPR增加NIHSS评分中位数6分(95％ CI3.68 ～ 8.31,P＜0.001),增加DWI梗死体积中位数2.8 cm3(95％ CI0.6 ～ 6.2,P＜ 0.01).结论 阿司匹林抵抗增加急性缺血性卒中患者的严重程度及梗死灶体积.