老年患者阿司匹林抵抗发生率及其相关危险因素分析

基础医学与临床 ›› 2021, Vol. 41 ›› Issue (7): 1035-1038.

老年患者阿司匹林抵抗发生率及其相关危险因素分析

赵艳秋¹, 梁伟^2*, 洪玉娥¹

1.合肥市第二人民医院老年科,安徽合肥 230011;
2.安徽医科大学第一附属医院肿瘤放疗科,安徽合肥 230000

收稿日期:2021-02-03 修回日期:2021-04-22 出版日期:2021-07-05 发布日期:2021-06-17
通讯作者: *34316801@qq.com
基金资助:
安徽省重点研发计划(201904a07020024)

Analysis of the incidence and related risk factors of aspirin resistance in elderly patients

ZHAO Yan-qiu¹, LIANG Wei^2*, HONG Yu-e¹

1. Department of Geriatrics, the Second People's Hospital of Hefei, Hefei 230011;
2. Department of Radiotherapy, the First Affiliated Hospital of Anhui Medical University, Hefei 230000,China

Received:2021-02-03 Revised:2021-04-22 Online:2021-07-05 Published:2021-06-17
Contact: *34316801@qq.com

摘要/Abstract

摘要： 目的探讨老年患者阿司匹林抵抗(AR)发生率及其相关危险因素。方法选取在2016年12月至2020年7月就诊于合肥市第二人民医院的90例老年患者,单一长期口服阿司匹林,服药时间在1年以上,每日剂量100 mg,使用血栓弹力图(TEG)仪检测阿司匹林对血小板的抑制率,同时检验所有患者一般生化指标,并对所获得的结果进行分析。以抑制率＜50%记录为AR,使用卡方检验评估AR与患者一般情况相关因素的关系。使用多因素Logistic分析老年患者AR的独立危险因素。结果共纳入90例患者,平均年龄(74.06±7.90)岁,AR为17.78%(16/90);AR在年龄、性别、吸烟、肌酐、尿酸等因素组间差异均无统计学意义,而空腹血糖、血小板计数、低密度脂蛋白(LDL)组间有明显差异(P＜0.05)。经Logistics分析,空腹血糖和LDL与老年患者 AR 发生密切相关(P＜0.01,OR=3.97,95% CI=0.89～ 9.71)(P＜0.05,OR=3.11,95% CI=2.42～4.01)。结论空腹血糖与LDL可能为老年患者AR的独立危险因素。应对此进行积极干预。

关键词: 血栓弹力图, 阿司匹林抵抗(AR), 空腹血糖, 低密度脂蛋白

Abstract: Objective To investigate the incidence and related risk factors of aspirin resistance (AR) in elderly patients. Methods Clincal data of ninety elderly patients who were treated in the Second People's Hospital of Hefei from December 2016 to July 2020 were collected. They took aspirin orally for more than one year with daily dose of 100 mg. The inhibition rate of aspirin on platelet was detected by thromboelastography(TEG), and the general biochemical indexes of all patients were tested. The results were analyzed, and the inhibition rate ＜50% was recorded as AR. Chi square test was used to evaluate the relationship between AR and related factors of patients' general condition. Multivariate logistic analysis was used to analyze the independent risk factors of aspirin resistance in elderly patients. Results A total of 90 patients were included, the average age was (74.06±7.90)years old, AR was 17.78% (16/90); AR had no significant difference in age, gender, smoking, creatinine, uric acid and other factors between groups, but there were significant differences in fasting blood glucose, platelet count, low density lipoprotein (LDL) between groups (P＜0.05). Logistic analysis showed that fasting blood glucose and LDL were closely related to the occurrence of AR in elderly patients (P＜0.01, OR=3.97, 95% CI=0.889-9.714), (P＜0.05, OR=3.11, 95% CI=2.42-4.01). Conclusions Fasting blood glucose and LDL seem to be the independent risk factors of AR in elderly patients. Active intervention is necessary to implement.

Key words: thromboelastography, aspirin resistance(AR), fasting blood glucose, low density lipoprotein

中图分类号:

R743.3

赵艳秋, 梁伟, 洪玉娥. 老年患者阿司匹林抵抗发生率及其相关危险因素分析[J]. 基础医学与临床, 2021, 41(7): 1035-1038.

ZHAO Yan-qiu, LIANG Wei, HONG Yu-e. Analysis of the incidence and related risk factors of aspirin resistance in elderly patients[J]. Basic & Clinical Medicine, 2021, 41(7): 1035-1038.

参考文献

[1]Fiolaki A,Katsanos AH,Kyritsis AP, et al. High on treatment platelet reactivity to aspirin and clopidogrel in ischemic stroke: a systematic review and meta-analysis[J]. Neurol Sci, 2017, 376: 112-116.
[2]Good RI, McGarrity A, James TE, et al. Dual antiplatelet response during PCI: verify Now P2Y12 predicts myocardial necrosis and thromboxane B2 generation confirms wide variation in aspirin response[J]. Thromb Res, 2015,135:1140-1146.
[3]Ardeshna D, Khare S, Jagadish PS, et al. The dilemma of aspirin resistance in obese patients[J]. Ann Transl Med, 2019, 7:404.
[4]Olechowski B, Ashby A, Mariathas M, et al. Is arachidonic acid stimulation really a test for the response to aspirin? time to think again?[J]. Expert Rev Cardiovasc Ther, 2017, 15: 35-46.
[5]李芳菲,刘东涛,周立春.脑小血管病患者阿司匹林抵抗的发生率及其与长期预后的关系[J].中国卒中杂志,2020,15:668-672.
[6]Pamucuk B. A review of aspirin resistance: definition, possible mechanisms, detection with platelet function tests 9 and its clinical outcomes[J]. J Thromb Thrombolysis, 2007, 23:213-222.
[7]Dussaillant NG, Zapata MM, Fardella BP, et al. Frequency and characteristics of aspirin resistance in chilean cardio-vascular patients[J]. Rev Med Chil, 2005, 133: 409-417.
[8]Ertugrul DT, Tutal E, Yildiz M, et al. Aspirin resistance is associated with glycemic control, the dose of aspirin, and obesity in type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2010, 95: 2897-2901.
[9]Akoglu H, Agbaht K, Piskinpasa S, et al. High frequ-ency of aspirin resistance in patients with nephrotic syndrome[J]. Nephrol Dial Transplant, 2012, 27: 1460-1466.
[10]杨颂,秦彦文.单基因脂代谢异常的研究进展[J].基础医学与临床, 2018, 38: 557-562.
[11]Liani R, Halvorsen B, Sestili S, et al. Plasma levels of soluble CD36, platelet activation, inflammation, and oxidative stress are increased in type 2 diabetic patients[J]. Free Radic Biol Med, 2012, 52:1318-1324.
[12]Cohen HW, Crandall JP, Hailpern SM, et al. Aspirin resistance associated with HbA1c and obesity in diabetic patients[J]. J Diabetes Complications, 2008, 22: 224-228.
[13]刘俊伟,李红梅,邓爱民.2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的危险因素研究[J].中国临床药理学杂志, 2018, 34:521-523.
effec[14]Tasdemir E, Toptas T, Demir C, et al. Aspirin resistance in patients with type Ⅱ diabetes mellitus[J]. Ups J Med Sci, 2014, 119:25-31.
[15]Wisniewski A. Multifactorial background for a low biolo-gical response to anti-platelet agents used in stroke prevention[J]. Medicina (Kaunas), 2021,57:59.doi:10.3390/medicina57010059.