Aspirin Resistance In Large-artery Atherosclerosis Cerebral Infarction And The Genetic Susceptibility Study

Part I:Study of the relationship between aspirin rsistance and recurrent stroke in Large-artery atherosclerosisObjective:To investigate Aspirin efficacy and it is prognosis in Large-artery athersoscleerosis. To explor the relationship between Aspirin resistanece and recurrent LAA.Methods:This study we enrolled206patients with first-ever LAA from March2010to March2011reigistered in Nanjing atroke refisty program(NSRP). All the patients were follow-up for12months since its first episode. According to whether have the recurrent LAA, all patients were divided into recurrent group and non-recurrent group. We choose the prospective cohort study, select206cases of the first-ever LAA patients in Nanjing Stroke Registry system.According to the result of12months followed-up, claddified to recurrent group and non-group. All patients received aspirin100mg/d7days and have thrombolastography(TEG) detection. To observed the relationship between Aspirin Resistance and recurrent LAA.Result:Of these patients, according to TEG,31cases(15.05%) are AR. The left175cases were AS. The average inhibitory rate of AA are (73.3+34.1%), After12months follow-up, with11(5.3%) cases dropped-out;9(4.4%) cases dead. According to the follow-up, all patients were divided into recurrent group(29cases) and non-recurrent group(177cases). The recurrent rate in AR group is higher than the AS group, the age, proportion of diabetes,and compliance is higher than the non-recurrent group(P<0.05). Through logistisic regression analysis, there is a strong correlation between aspirin hyesistance and recurrent LAA.(OR=4.716,P=0.008).Conclusion:TEG can be effectively detect aspirin resistance and the rate of AR in LAA is15.05%. AR can significantly increase the risk of recurrent LAA. Objective:To explore association between aspirin resistance and A1622G and C893T of P2Y1gene and T196C of ITGB3gene polymorphisms.Methods:We enrolled206patients with first-ever LAA from March2010to March2011reigistered in Nanjing stroke registy program(NSRP). According to TEG, all patients were classified to aspirin resistance (AR)group and aspirin sensitive(AS) group, to analysis the related genes polymorphism by Taqman fluorescence detection method.Results:(1) According to TEG, all patients were classified to aspirin resistance group andaspirin sensitive group.The rate of blood pressure, smoking and poor compliance of anti-platelet drugs in AR group is higer than AS group(p<0.05).(2) The rs701265AG plus GG genotype frequency in AR group were significantly higher than those in AS group(67.7%vs46.3%,OR=2.44,95%CI=1.09-5.48,P=0.03). rs5918and rs1065776in two groups, the statistics of the genotype frequency have no difference (P>0.05).(3) It was also found that in smoking AR group and in poor compliance of anti-platelet drugs AR group,the rs701265AG plus GG genotype frequencies were significantly higher than those in smoking control group and in poor compliance of anti-platelet drugs control group(OR=4.14,95%CI=1.19-14.41; OR=5.33,95%CI=1.32-21.53).(4) Haploview4.0software show that, there is no obvious differences between rs1065776and rs701265there is no linkage disequilibrium.Conclusion:The G allele in rs701265loci of P2Y1may be a fenetic risk factor for AR in LAA patients.The association is predominant in LAA patients of smoking and poor compliance of anti-platelet drugs.