| BackgroudStroke is currently the third cause of death in the world,following cardiovascular disease and cancer,while in China,according to the Ministry of Health's report, cerebrovascular disease has become China's second fatal disease,in which,ischemic cerebrovascular disease accounts for about 80%of the total.Ischemic cerebrovascular disease as a disease that can be prevented,the recurrence and disability rate could be reduced by seriously implementing the secondary prevention measures and control risk factors.Patients' knowledge with risk factors of diseases directly affects the level of understanding of the implementation of the treatment and the compliance to the medical prescription and then influences the effectiveness of treatment. Therefore,we carried out the survey,to guide those patients' contolling risk factors and choosing prevention medication in accordance with the specific circumstances.On the other hand,aspirin because of its role in anti-platelet aggregation and has become the first-line drugs in the prevention of ischemic stroke,but even if some high-risk patients taking anti-platelet drugs regularly,recurrent vascular accident still could happen within 2 years.In addition to the impact of treatment compliance,the aspirin in the body could not achieve the therapeutic effect is one of the important reasons,which was called "aspirin resistance"(AR).There have been some studies on the incidence of aspirin resistance and the mechanism,but there was still lack of systematic research about Chinese patients.We designed a sample survey,to study the incidence of aspirin resistance and clinical factors of relevance in Chinese patients with ischemic cerebrovascular disease;and developed genetic testing,to explore aspirin resistance-related genes' single nucleotide polymorphisms and related molecular mechanism,provided strategy for the individual treatment programs. Part 1.Knowledge and conrolling of risk factors in Chinese lschemic Cerebrovascular Diseases PatientsObject:The current study aims to investigate the patients' knowledge and controlling of risk factors of ischemic cerebrovascular diseases.Method:(1) During November 2007 to December 2008,315 cases of symptomatic ischemic cerebrovascular disease patients were admitted in Peking Union Medical College Hospital and Beijing Xuanwu Hospital,which were Surveyed by specialized staff.(2) The questionnaire had two sections:socio-demographics characteristics, awareness of risk factors of stroke and self-control;(3) Inclusion criteria:18-85 years old,had TIAs or minor stroke before admission,had cerebrovascular stenosis comfirmed by vascular exam,cooperated with the investigation and with the informed consent;(4) Exclusion criteria:had serious residualpost-stroke dysfunction and could not take care of themselves,can not cooperate with the investigation or who do not want to participate in the investigation;(5) Results were analysised by SPSS 11.5(Statistical Package for Social Sciences,Lead Technologies,Inc.,Chicago,IL,USA).Result:(1) Of 315 participants,176 male and 139 were females with a mean age 60.03±11.97;(2) The distribution of risk factors:Physical inactivity(68.6%),smoking (65.7%),obesity(65.7%),hypertension(60.0%),alcoholism(51.4%),hyperlipidemia (40.0%),diabetes(37.1%),ischemic family history(36.8%),coronary heart disease (28.6%);(3) 68.6%(261/315) of participants admitted to know the disease can be prevented;91.4%(288/315) of participants admitted that they were aware of at least one risk factor for stroke;(4) Among risk factors,physical inactivity was ranked as the most common (68.6%,216/315),followed by smoking(65.7%,207/315),obesity(65.7%,207/315), hypertension(60%,189/315),alcohol(51.4%,162/315),high blood lipids(40%, 126/315),diabetes(37.1%,117/315),family history of stroke(36.8%,116/315),coronary heart disease(28.6%,90/315); (5) Binary Logistic Regression analysis showed that the factors related to the level of awareness were determined to be:levels of education and sports,OR values were 13.460(95%CI,6.249～28.994) and 11.761(95%CI,4.361～31.716).Conclusion:At present,patients' awareness of risk factors and controlling situation is far from ideal,that call for more public education and make the patient-specific guidance.Part 2.Ischemic Cerebrovascular Disease Patients' Aspirin Treatment Compliance and Its Impact FactorsObject:To explore the ischemic cerebrovascular disease patients' compliance to aspirin treatment and the influential factors.Method:(1) Participants:symptomatic ischemic cerebrovascular disease patients were admitted in Peking Union Medical College Hospital and Beijing Xuanwu Hospital during November 2007 to December 2008.(2) Inclusion and exclusion criteria were the some to the Part 1.(3) Investigated the participants' compliance and carried out follow-up to observe changing of comliace;(4) Statistical analysis participants socio-demographics characteristics and compliance to aspirin;relationship assessments of compliance were performed utilizing logistic regression;observe and analyze the patients admitted to hospital before and after changes in medication compliance.Result:(1) 191 cases,accounting for 60.6%of all patients had good compliance before admission;47 cases completely ceased medication,accounting for 14.9 percent of the total number;(2) The patient's place of residence,educational attainment,household income, occupational situation,health insurance,physical activity,smoking,as health care workers or had friends or relatives as health care workers were different distribution in both groups and had significant differences;(3) Multivariate analysis(Binary Logistic Regression) found that only place of residence(rural/urban) and whether their own or friends and relatives as medical workers had significant relationship with drug compliance,OR values were 5.328(95% CI,3.157～8.994) and 2.727(95%CI,1.327～5.603);(4) Post-discharge follow-up to medication compliance of patients found good compliance in 201 cases,accounting for 79.1%of the total number of follow-up, complete cessation of medication in 6 patients,accounted for 3.5%of the total number of follow-up patients,compliance had significantly improved compared to pre-hospital;(5) Patient's self-report reasons for poor compliance were:inadequate understanding of disease,consider the disease has been cured,perceived good health and that the drug does not work,for economic reasons,the work reasons and difficulties in hospitalizing.Conclusion:(1) Patients with lower drug compliance pre-hospital;(2) Compliance improved after discharge;(3) The need to strengthen disease education and patient communication.Part 3.The Distribution of Aspirin Resistance and Related Gene Polymorphism in Ischemic Cerebrovascular Disease PatientsObject:Utilize thromboelastography to screen aspirin-resistance in ischemic cerebrovascular disease patients,and detection of related gene SNP polymorphisms to explore its relationship to aspirin resistance,in order to further explore the mechanism of aspirin resistance and achieve individualized treatment to reduce the incidence of thrombosis.Method:(1) During November 2007 to December 2008,315 cases of symptomatic ischemic cerebrovascular disease patients were admitted in Peking Union Medical College Hospital and Beijing Xuanwu Hospital,from which chose the patients willing to participate in the study.(2) Inclusion criteria:18-85 years old,at least consecutively used aspirin for 7 days before admission,had TIAs or minor stroke before admission,had cerebrovascular stenosis comfirmed by vascular exam,cooperated with the investigation and with the informed consent.(3) Exclusion criteria:had serious residualpost-stroke dysfunction and could not take care of themselves,platelet count greater than 450×10~9/L or less than 100×10~9/L,hemoglobin less than 80g/L;patients with malignant plasma cells or myelodysplastic syndrome,recent history of major surgery,used of Ticlopidine, traditional non-steroidal anti-inflammatory drugs and heparin,low molecular weight heparin,warfarin in the past weeks,can not cooperate with the investigation or who do not want to participate in the investigation;(4) Utilized TEG to detect patients' platelet function and divided them to AR group or AS group;(5) Utilized SNPStream technique to detect AR related gene SNPs distribution and explore their relationship;(6) Using SPSS 11.5,haploview 4.1 and online tool SNPstats to conduct statistical and biological genetics analysis.Result:(1) 220 patients participated in this study,171 male and 49 were females with a mean age 58.7±10.4;(2) Using of thromboelastography(TEG) technology,19 cases were diagnosed had aspirin resistance(AR),accounting for 8.64%of the total number;(3) Statistical analysis showed that age,WBC,RBC,Hgb,PLT,Alb,TG levels were higher in the AR group than in the AS group,but no significant difference(P>0.05); ALT,TCH,HDL,LDL,CRP,APTT,Fib levels of the AR group were higher than in the AS group,but no significant difference(P>0.05);the proportion of males and females between the two groups no significant difference(P>0.05);in AR group the prevalence of hypertension was lower than in the AS group(P=0.025),the distribution of other risk factors were no significant difference in two groups(P>0.05);(4) SNPStream detection showed that:allele frequency distribution between AS and AR group were significantly different at four SNP sites,these were PTGSl-rs3842788(P<0.005),ITGA2B-rs5911(P<0.001),P2RY1-rs16864613(P <0.001),P2RY12-rs6809699(P<0.001);(5) Unconditioned Logistic Regression analysis showed that PTGS1-rs3842788, ITGA2B-rs5911,P2RY1-rs16864613,P2RY12-rs6809699 were associated with the occurrence of AR.Conclusion:(1) In this study the occurrence rate of AR was 8.64%;(2) Between AS and AR group,clinical status and biochemical test results no significant differences had no significant differences except the prevalence rate of hypertension;(3) Morphrism of PTGS1-rs3842788,ITGA2B-rs5911, P2RY1-rs16864613 and P2RY12-rs6809699 were associated with the occurrence of AR.
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