血栓弹力图评价急性心肌梗死患者经皮冠状动脉介入术后阿司匹林抵抗及其影响因素

Aspirin resistance and its influencing factors in acute

摘要:

目的 利用血栓弹力图（TEG）结果评价急性心肌梗死患者经皮冠状动脉介入（PCI）治疗后的阿司匹林抵抗（AR）发生率，并分析其影响因素，为患者个体化治疗提供依据。方法 选取2014年来我院就诊的急性心肌梗死PCI术后患者170例，收集并分析患者的临床资料及其TEG结果，根据TEG检测花生四烯酸抑制率（AA抑制率）分为阿司匹林敏感组（105例）及AR组（65例），对两组患者的临床资料进行单因素及多因素logistic回归分析。结果 170例患者AR发生率为38. 2%（65/170），AR组和阿司匹林敏感组AA抑制率分别为（32. 14±12. 77）%和（74. 48±16. 19）%。两组患者长期吸烟史、高脂血症病史比较，差异具有统计学意义（P＜0.05），性别、年龄、长期饮酒史、糖尿病病史、高血压病史、心律失常病史及血常规、生化指标、TEG各参数比较，差异均无统计学意义（P＞0.05）。多因素logistic回归分析结果显示，长期吸烟为AR的影响因素。结论 长期吸烟可能是急性心肌梗死行PCI术后发生AR的危险因素。

Abstract:

Objective To observe the incidence of aspirin resistance (AR) in the patients with acute myocardial infarction after percutaneous coronary intervention (PCI) by thromboelastography (TEG), and analyze its influencing factors to provide the basis for individualized treatment. Methods A total of 170 patients with acute myocardial infarction undergoing PCI in our hospital in 2014 were enrolled in this study. Their clinical data and TEG results were collected and analyzed. The patients were divided into aspirin sensitive group (n＝105) and AR group (n＝65) based on the inhibitory rate of arachidonic acid (AA). Univariate and multivariate logistic regression analyses were carried out on the obtained clinical data of the two groups. Results The incidence of AR was 38.2% (65/170), and the inhibitory rate of AA was (32. 14±12. 77)% in AR group, and (74. 48±16. 19)% in aspirin sensitive group. Histories of long- term smoking and hyperlipidemia were statistically different between the two groups (P＜0.05), but sex, age, long- term drinking, diabetes, hypertension, arrhythmia, indices of blood routine and biochemical examination, and TEG parameters had no statistical discrepancies (P＞0.05). Multivariate regression analysis showed that long- term smoking was an influencing factor of AR. Conclusion Long- term smoking may be a risk factor for AR in the patients with acute myocardial infarction after PCI.