老年心脑血管疾病中阿司匹林抵抗现象的研究-内科学(心血管病)专业论文.docxVIP

酝江夫学磺士学位论文结 酝江夫学磺士学位论文 结 果 1．两组剂量阿司匹林治疗前后自身对照研究，显示两组剂量的阿司匹林均能有 效抑制血小板聚集率和抑制血清TXB：水平。但是，在老年心脑血管疾病患者中， 阿司匹林治疗剂量不同的两组均有阿司匹林抵抗，分别是低剂量组占40％和高 剂量组占30．3％。 2．低剂量阿司匹林治疗后，与非阿司匹林抵抗组相比，阿司匹林抵抗现象在不 稳定性心绞痛患者中显著增加(P0．01)；而在高剂量组中，阿司匹林抵抗与非 阿司匹林抵抗在不稳定性心绞痛患者的发生比率上无统计学上差异(P0．05)。 3．观察不稳定性心绞痛和稳定性心绞痛患者之间的阿司匹林抵抗情况时发现， 在阿司匹林抵抗发生率上，两组之间有统计学差异(PO．01)，在不稳定性心绞 痛患者中阿司匹林抵抗发生率较高。 结 论 无论阿司匹林治疗剂量高低，老年心脑血管疾病患者中均有部分患者出现 阿司匹林抵抗。但是，在不稳定性心绞痛中，高剂量阿司匹林治疗后产生阿司 匹林抵抗较少。不稳定性心绞痛可能是阿司匹林抵抗的影响因素。对于不稳定 性心绞痛患者高剂量阿司匹林可能有更有效的抗血小板作用，能减少阿司匹林 抵抗的发生。提示，对于老年不稳定性心绞痛患者，应该早期进行血浆TXB2 及血小板聚集率测定，及早发现阿司匹林抵抗现象。 关键词：阿司匹林抵抗不稳定性心绞痛剂量 老年心脑血管疾病 2 Effect Effect of different-dose aspirin to the cardio-cerebrai-vascular diseases patients with aspirin resistance Yu wei，Hu shengjiang．The First Affiliated Hospital，Zbejiang University School of Medicine，Hangzhou 310009 China Background：acetylsalicylic acid Was found in 1897，and called as aspirin．In 70’s， John found that Aspirin could significantly decrease platelet function by irreversibly acetylating the cyclooxygenase．Then,it is widely used to lxeat the cardio—cerebral-vascular diseases．In 1994，a meta-analysis study including more than 1000000 patients has documented the effect of aspirin in reduction of death, myocardial infarction and stroke in high-risk vascular patients，a 48％reduction in vascular Faft and arterial occlllsiona 67％reduction ofpulmonary embolism，and a 23％reduction of deep venous thrombosis．In 2002，other meta-analysis study including more than 2000000 patients also demonstrateA 22％reduction of ischemic vascular events．However,some clinical studies appeared a part of patients with cardio—·cerebral·-vascular diseases experience thrombotic or embolic vascular events despite being on aspirin therapy．Furthermore，several experimental studies have shown that aspirin function Was not inhibited effetely in some patients．This phenomenon is called鹤aspirin resistance㈥．Certainly,the results of studies were different．and the prevalence of aspirin resistance varies between 5％and 4