本文關(guān)鍵詞： 缺血性腦卒中 阿司匹林抵抗 危險因素　出處：《東南大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景缺血性腦卒中,是指因腦部血液循環(huán)障礙,缺血或缺氧所致的局限性腦組織的缺血性壞死或軟化。大量循證醫(yī)學(xué)證據(jù)表明,阿司匹林在缺血性腦血管病的預(yù)防中具有重要價值,可顯著減少各類栓塞及血栓形成事件的發(fā)生率。阿司匹林主要通過脂肪酸環(huán)氧酶-1(COX-1)活性部位的529位絲氨酸被不可逆地乙�；�,阻止花生四烯酸(AA)結(jié)合其乙�；稽c,抑制血栓素A2(TXA2)的合成,從而發(fā)揮抗血小板聚集作用。但是,我們在臨床實踐中觀察到并非所有服用阿司匹林者均能獲得良好的臨床效果,在進(jìn)行阿司匹林治療的心腦血管疾病患者中,仍有血栓形成或栓塞事件發(fā)生,稱之為臨床阿司匹林抵抗。同時很多實驗室檢查研究也發(fā)現(xiàn)接受阿司匹林治療的患者的血小板活性不能被充分抑制,稱之為實驗室阿司匹林抵抗。有研究表明實驗室阿司匹林抵抗與臨床阿司匹林抵抗相關(guān)。阿司匹林抵抗的檢出率波動很大并且依賴于制定此條件的標(biāo)準(zhǔn)。在Z-HXu等人采用光透射聚集儀(LTA)、血小板功能分析儀(PFA)、血栓彈力圖(TEG)、11-去氫-血栓烷B2含量及P選擇素測定來評估阿司匹林對血小板作用的研究中,將公認(rèn)的判定血小板活化狀態(tài)的“金標(biāo)準(zhǔn)”一P選擇素陽性的血小板用作基線標(biāo)準(zhǔn),血栓彈力圖一花生四烯酸(TEG-AA)血小板圖實驗有更高的敏感性、特異性以及和P選擇素測定的一致性,且操作簡便、重復(fù)性好,更有助于制定個體化的抗血小板治療方案。本研究采用TEG-AA血小板圖實驗來檢測患者是否對阿司匹林抵抗,通過調(diào)查缺血性腦卒中患者阿司匹林抵抗的危險因素,以期為腦血管病的臨床防治提供依據(jù)。目的 調(diào)查缺血性腦卒中患者阿司匹林抵抗的相關(guān)危險因素。方法2013年11月至2015年03月入住東南大學(xué)附屬中大醫(yī)院神經(jīng)內(nèi)科患者中,入選經(jīng)頭顱核磁共振(MRI)平掃或電子計算機斷層掃描(CT)平掃證實存在缺血性腦卒中且均行TEG-AA實驗室檢查的患者163例。錄入入組患者人口學(xué)資料、基礎(chǔ)疾病、血液學(xué)指標(biāo)、TEG-AA抑制率值。TEG-AA抑制率20%為阿司匹林抵抗,20%≤TEG-AA抑制率≤50%為阿司匹林半抵抗,TEG-AA抑制率50%為阿司匹林敏感,阿司匹林抵抗及半抵抗合稱為阿司匹林非敏感。進(jìn)行相關(guān)性分析,總結(jié)出入組缺血性腦卒中患者阿司匹林抵抗的危險因素。結(jié)果研究期間共納入163例患者,其中阿司匹林敏感組132例,阿司匹林非敏感組31例,包括阿司匹林抵抗組15例,阿司匹林半抵抗組16例。在阿司匹林敏感組與非敏感組對比中,采用獨立樣本t檢驗對定量指標(biāo)的分布進(jìn)行差異檢驗、卡方檢驗對定性指標(biāo)的分布進(jìn)行差異檢驗,顯示僅是否患有冠心病一項指標(biāo)在兩組對比中p0.05,說明是否患有冠心病在兩組間存在統(tǒng)計學(xué)意義,回歸分析顯示患有冠心病的回歸系數(shù)為0.987,為正,冠心病對阿司匹林半抵抗相對危險度為0.373(0.163,10.852),說明患有冠心病的患者阿司匹林非敏感的可能性高。在阿司匹林敏感組與抵抗組對比中,采用獨立樣本t檢驗對定量指標(biāo)的分布進(jìn)行差異檢驗、卡方檢驗對定性指標(biāo)的分布進(jìn)行差異檢驗,顯示空腹血糖(FBG)、糖化血紅蛋白(HbA1c)指標(biāo)在兩組對比中p0.05,說明空腹血糖、糖化血紅蛋白在兩組間存在統(tǒng)計學(xué)意義,回歸方程分析顯示空腹血糖、糖化血紅蛋白兩項指標(biāo)p值均大于0.05未能進(jìn)入回歸方程,說明糖化血紅蛋白、空腹血糖對阿司匹林抵抗無顯著性。在阿司匹林敏感組與半抵抗組對比中,采用獨立樣本t檢驗對定量指標(biāo)的分布進(jìn)行差異檢驗、卡方檢驗對定性指標(biāo)的分布進(jìn)行差異檢驗,顯示僅是否患有冠心病一項指標(biāo)在兩組對比中p0.05,說明是否患有冠心病在兩組間存在統(tǒng)計學(xué)意義,回歸分析顯示患有冠心病的回歸系數(shù)為1.552,為正,冠心病對阿司匹林半抵抗相對危險度為4.720(1.553,14.352),說明患有冠心病的患者阿司匹林半抵抗的可能性高。在阿司匹林抵抗組與半抵抗組對比中,采用獨立樣本t檢驗對定量指標(biāo)的分布進(jìn)行差異檢驗、卡方檢驗對定性指標(biāo)的分布進(jìn)行差異檢驗,顯示糖化血紅蛋白在兩組對比中p0.05,說明糖化血紅蛋白在兩組間存在統(tǒng)計學(xué)意義,回歸分析顯示糖化血紅蛋白回歸系數(shù)為0.925,為正,糖化血紅蛋白對阿司匹抵抗相對危險度為2.523(1.188,5.357),說明糖化血紅蛋白值越高的患者阿司匹林抵抗的可能性越高。結(jié)論 本研究結(jié)果提示一定數(shù)量的缺血性腦卒中患者在服用阿司匹林時未能達(dá)到理想的抗血小板聚集作用。本研究提示患有冠心病和高糖化血紅蛋白為阿司匹林抵抗的危險因素。
[Abstract]:Background ischemic stroke, is due to the disturbance of blood circulation, local brain tissue caused by hypoxia ischemia or necrosis or softening. A large number of evidence-based medical evidence that aspirin has important value in the prevention of ischemic cerebrovascular disease, can significantly reduce the incidence of thrombosis and embolism. Aspirin the fatty acid cyclooxygenase -1 (COX-1) 529 serine active site was not reversible acetylation, stop four arachidonic acid (AA) combined with its acetylation sites, inhibition of thromboxane A2 (TXA2) synthesis from play a role in platelet aggregation. However, we have observed in clinical practice not all aspirin the patients could obtain good clinical effect in the treatment of aspirin, cardiovascular and cerebrovascular disease patients, there is still the event of thrombosis or embolism, called clinical aspirin against At the same time. Many anti laboratory studies have found that platelet activity cannot accept asplineaspirin is sufficiently suppressed, known as aspirin resistance. Laboratory studies show that laboratory aspirin resistance associated with aspirin resistance. Clinical aspirin resistance detection rate fluctuates greatly and depends on the development of this condition. The standard light transmission aggregometer in Z-HXu et al (LTA), platelet function analyzer (PFA), Thrombelastogram (TEG, 11-) to the hydrogen content of B2 and P were selected to evaluate the determination of thromboxane on platelet function in aspirin, determination of platelet activation will be recognized as the "gold standard" P were used as the baseline platelet selection standard Thrombelastogram, a four arachidonic acid (TEG-AA) platelet diagram experiment has higher sensitivity, specificity and consistency of P selectin and determination, and the operation is convenient. As a simple, reproducible, more conducive to the development of individualized antiplatelet therapy. This study used TEG-AA platelet mapping experiments to test whether patients on aspirin resistance, through the investigation of aspirin resistance in patients with ischemic cerebral stroke risk factors, provide the basis for clinical prevention and treatment for cerebral vascular disease. Objective to investigate the risk of aspirin resistance in patients with ischemic stroke. Methods from November 2013 to 2015 03 months in the neurology department of Zhongda Hospital Affiliated to Southeast University were selected, the head magnetic resonance imaging (MRI) scan or computed tomography (CT) scan confirmed the existence of 163 cases of patients with ischemic stroke and TEG-AA were performed in laboratory examination. Entry into the group of patients with basic demographic data, the disease, hematological indexes, TEG-AA inhibition rate value.TEG-AA inhibition rate of 20% for aspirin resistance, 20% TEG-AA inhibition rate is less than 50 % for aspirin resistance, the inhibition rate of TEG-AA 50% for aspirin sensitive, aspirin resistance and resistance are called non aspirin sensitive. Through correlation analysis, summed up the entry group of aspirin resistance in patients with ischemic cerebral stroke risk factors. Results during the study period, a total of 163 patients were enrolled, including aspirin sensitive group 132 cases, 31 cases of non aspirin sensitive group in 15 cases, including aspirin resistance group, aspirin resistance group 16 patients in the aspirin sensitive group and non sensitive group comparison, independent samples t tests were used to test the difference of distribution of quantitative indicators, differences in testing the chi square test of qualitative index distribution, only an indicator of whether P0.05 patients suffering from coronary heart disease in two groups in contrast, whether suffering from coronary heart disease had statistical significance between the two groups, regression analysis showed that the regression coefficient was 0.987 for patients suffering from coronary heart disease. The relative risk of coronary heart disease, aspirin resistance was 0.373 (0.163,10.852), that suffers from coronary heart disease patients in aspirin sensitive non high possibility. In aspirin sensitive group and resistant group comparison, independent samples t tests were used to test the difference of distribution of quantitative indicators, differences in testing the chi square test of qualitative index distribution. According to the fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c) index in the two group comparison that P0.05, fasting blood glucose, glycosylated hemoglobin had statistical significance between the two groups in the regression equation analysis show the fasting blood glucose, glycosylated hemoglobin two index p values are greater than 0.05 that failed to enter the regression equation, HbA1c, fasting blood glucose aspirin resistance was not significant. In aspirin sensitive group and resistant group comparison, independent samples t test was used to quantitative index distribution difference Different test of difference test chi square test of qualitative index distribution, only an indicator of whether P0.05 patients suffering from coronary heart disease in two groups of contrast, whether suffering from coronary heart disease had statistical significance between the two groups, regression analysis showed that the regression coefficient was 1.552 with coronary heart disease, coronary heart disease is positive, the relative risk of aspirin resistance. 4.720 (1.553,14.352), indicating the possibility of coronary heart disease patients of aspirin resistance is high. In aspirin resistance group and semi resistance group comparison, independent samples t tests were used to test the difference of distribution of quantitative indicators, differences in testing the chi square test of qualitative index distribution, display of glycosylated hemoglobin in two groups of contrast in P0.05 note, glycosylated hemoglobin had statistical significance between the two groups, regression analysis showed that HbA1c regression coefficient was 0.925, positive, glycated haemoglobin Protein on aspirin resistance relative risk was 2.523 (1.188,5.357), indicating the HbA1c value is higher in patients with aspirin resistance probability is higher. Conclusion the results of this study indicated that a certain number of ischemic stroke patients taking aspirin failed to reach the ideal. This study suggests that platelet aggregation with coronary heart disease and HbA1c for risk aspirin resistance factors.

【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 柏燕燕;孔玉;高志強;朱祖，

本文編號：1459221