大动脉粥样硬化性脑梗死的复发与阿司匹林抵抗的相关危险因素分析

摘要

Objective To study the impact of aspirin resistance(AR)on the recurrence of artery athero-sclerotic cerebral infarction,and analyze the risk factors of AR. Methods According to TOSAT classification, newly diagnosed cerebral infarction patients with artery atherosclerotic cerebral infarction were selected into groups,and aspirin enteric-coated tables(ASP)was used to prevent platelet aggregation.One week later,the inhi-bition rate of platelet was detected by thrombelastogram(TEG),and the patients were divided into aspirin sensi-tive(AS)group and AR group,and were followed-up for at least 6 months.According to whether they were recur-rent cerebral infarction,the patients were divided into recurrent group and non-recurrent group. Then,statistical analysis was conducted.Results The incidence rate of AR in recurrent group was significantly higher than that in non-recurrence group(P < 0.05);the recurrence rate of cerebral infarction in AR group was significantly higher than that in AS group(P<0.05).When compare the clinical indexes between the recurrence group and non-recur-rence group,age,diabetes,TC,Hcy,Apo-a in the two groups were different(P<0.05).In recurrent group,the distribution of diabetes,LDL-C and Hs-CRP were different between AR and AS group(P<0.05).Age,gender, hypertension,diabetes,Hs-CRP and TC were risk factors for AR.Conclusions AR plays an important role in the relapse of artery atherosclerotic cerebral infarction and it is more likely to occur especially accompanied by adverse factors such as underlying diseases. TEG can be used to detect AR rapidly and conveniently,which has practical significance in preventing recurrent cerebral infarction.%目的 研究阿司匹林抵抗(AR)对大动脉粥样硬化性脑梗死复发的影响,并分析AR产生的危险因素.方法 根据TOSAT分型,选择新发大动脉粥样硬化性脑梗死患者入组,予阿司匹林肠溶片(ASP)抗血小板聚集,1周后用血栓弹力图(TEG)检测血小板抑制率,并分为阿司匹林敏感(AS)组和AR组,跟踪至少6个月;根据有无脑梗死复发分为复发组和非复发组;最后统计分析.结果(1)复发组AR发生率显著高于非复发组(P<0.05);(2)AR组脑梗死复发率明显高于AS组(P<0.05);(3)复发组与非复发组相关临床指标比较时,年龄、糖尿病、TC、Hcy、Apo-a在两组之间有差异(P<0.05);(4)复发组中AR和AS之间,糖尿病、LDL-C和Hs-CRP在两组间分布不同(P<0.05);(5)年龄、性别、高血压病、糖尿病、Hs-CRP、TC是AR的危险因素.结论 AR对大动脉粥样硬化性脑梗死的复发有重要影响,尤其在伴有基础疾病等不良因素时AR更易发生,TEG能方便快速检测AR,这对及时预防脑梗死复发有实际意义.