| Effect of aspirin on platelet aggregation has been widely used for ischemic cardiovascular and cerebrovascular disease prevention and control work. A lot of evidence showed that preventive effect of level one or two from aspirin can reduce the incidence of cerebral infarction, recurrence rate and mortality rate. However, a considerable part of patients with antiplatelet therapy presented with recurrent events, even multiple ischemic cardiovascular and cerebrovascular disease, known as aspirin resistance (AR) phenomenon. Patients regularly taking regular doses of aspirin is still not reduce clinical arterial thrombotic events, called for clinical aspirin resistance. Platelet function monitored through the laboratory method has not been effectively inhibited, called for biochemical aspirin resistance. Previous study shows, the risk of recurrent ischemic vascular events in patients with aspirin resistance increase. The pathogenesis of aspirin resistance is still not completely clear, which may include clinical factors, cellular factors, genetic factors, etc.. Atherosclerotic cerebral infarction is the major type of cerebral infarction, which has a higher incidence rate, recurrence rate and morbidity rate. The more times of recurrence, the more severe condition and the worse prognosis of atherosclerotic cerebral infarction. Aspirin resistance in the recurrence of cerebral infarction and various factors associated with aspirin resistance has attracted wide attention. Our subject aims to investigate the clinical factors related to recurrence of atherosclerotic cerebral infarction in acute stage and aspirin resistance. We hope to provide a guidance in the course of integrated control in patients with atherosclerotic cerebral infarction, and help in the implementation of individualized antiplatelet therapy.Objective:to investigate related factors of aspirin resistance in patients with recurrent artery atherosclerotic (AT) cerebral infarction.Methods:we enrolled407petients with new-onset AT cerebral infarction, who are taking aspirin100mg/d) for at least thirty days. They were divided into primary and recurrent groups,216cases and191cases respectively. We compared the differences of platelet aggregation (Pag) and other clinical features of the two groups. Platelet aggregation rate induced by adenosinediphosphate (ADP) and arachidonic acid (AA) were determined by whole blood impedance method. According to the Pag, the recurrent group was divided into three subgroups:aspirin resistance (AR), asirin semi-resistance (ASR), aspirin sensitivity (AS). Differences of clinical characteristics among the three groups were analyzed to look out the correlative factors of aspirin resistance. Gender, age, body mass index (BMI), abdominal circumference, past medical history and taking antiplatelet drug history, smoking history, China Stroke Scale (CSS) score were collected and evaluated within24hours after admission. Electrolyte, blood routine examination, liver and kidney function, blood coagulation function of platelet aggregation rate, homocysteine (HCY) and other indicators were detected.Results:1、The primary group, the incidence of AR was5.09%, the incidence of ASR was16.67%, and the incidence of AS was78.24%, The recurrent group, the incidence of AR was12.57%, the incidence of ASR was30.37%, and the incidence of AS was57.06%, The incidence of AR\ASR\AS was statistically significant different (P<0.05) between the recurrent group and the primary group.2、BMI, abdominal circumference, CSS score, AA-induced platelet aggregation rate, and the proportion of AR were statistically significant greater in the recurrent group than in the primary group (P<0.05).3、AA-induced platelet aggregation rate was positively correlated with CSS scores in both the recurrent group and primary group.4、In the recurrent group, AR subgroup had most male patients as compared to the subgroups of ASR or AS (P<0.05). Age, BMI and waist size between the three subgroups had no significantly difference (P all>0.05).5、In the recurrent group, Compared to the subgroups of ASR or AS, AR subgroup had more patients suffered from diabetes, hyperlipidemia, excessive drinking patients (P all<0.05). The correlative analysis showed that, the diabetes, hyperlipidemia, excessive drinking was associated with the occurrence of AR. 6、In the recurrent group, CSS score, HCY, FIB, Ga2+level of AR subgroup were statistically higher than those of the other two subgroups (P<0.05).7、Multivariate Logistic regression analysis showed that diabetes and hyperlipidemia are still relevant to AR in recurrent atherosclerotic cerebral infarction.Conclution:1、The incidence of AR in the recurrent group was significantly higher than that in the primary group, suggesting that AR might play an important role in the recurrence of atherosclerotic cerebral infarction. Compared with the primary group, CSS score was higher in the recurrent group, indicating more severe condition. AA-induced Pag was positively correlated to CSS score in both the primary group and recurrent group. The higher CSS score, the more severe condition. Higher AA-induced Pag suggests that the severity of acute period was related to the degree of platelet activity.2、Diabetes, hyperlipidemia may be the independent clinical factors for AR in recurrent atherosclerotic cerebral infarction. Regulation of blood lipid and blood sugar level may not only reduce the risk of stroke, but also help to reverse aspirin resistance.3、In clinical practice, when the patients, who taking routine aspirin, still suffer from the occurrence or recurrence of ischemic cerebrovascular disease, the possibility of aspirin resistance should be took into consideration. The platelet aggregation rate should be mornitored in this condition. The best choice of antiplatelet drugs, the scientific management of diabetes and hyperlipidemia would be taken into the comprehensive, individual treatment strategies. |
PDF Full Text Request