CAJ | 학술논문

目的观察老年患者对阿司匹林的反应性及其影响因素,以及阿司匹林与消化道出血的关系.方法入选136例缺血性心血管疾病及高危老年患者,用药前和阿司匹林100 mg/d服用7d后检测花生四烯酸诱导的血小板聚集率(AA-Ag).将用药前AA-Ag按四分位数平均分为4组,观察用药后AA-Ag水平变化及临床和实验室指标,并观察6个月内消化道出血情况.结果用药前患者AA-Ag为73.20％±7.32％,阿司匹林用药后AA-Ag为12.91％±5.43％,波动范围0.42％～30.50％,11.8％的患者用药后AA-Ag≥20％.用药前AA -Ag与用药后AA-Ag呈正相关(r=0.493,P＜0.01),第四分位数组的治疗后AA-Ag高于其他分位数组.≥80岁组用药后AA-Ag为10.25％±4.68％,明显低于60～69岁组和70～79岁组.用药后AA-Ag低于下四分位数的患者在≥80岁组(13例,38.2％)明显多于其他年龄组[分别为11.1％ (3/27)和24.0％ (18/75),P均＜0.05].多因素分析表明,用药前AA-Ag(P =0.001)、年龄≥80岁(P =0.009)、急性冠状动脉综合征(P=0.026)、糖尿病(P=0.017)均是用药后AA-Ag的独立预测因素.4例(2.9％)发生消化道出血,其中3例用药后AA-Ag低于下四分位数.结论老年患者的阿司匹林反应性个体差异大,用药前血小板活性可预测阿司匹林反应性,高龄患者对阿司匹林更敏感.
목적 관찰노년환자대아사필림적반응성급기영향인소,이급아사필림여소화도출혈적관계.방법 입선136례결혈성심혈관질병급고위노년환자,용약전화아사필림100 mg/d복용7d후검측화생사희산유도적혈소판취집솔(AA-Ag).장용약전AA-Ag안사분위수평균분위4조,관찰용약후AA-Ag수평변화급림상화실험실지표,병관찰6개월내소화도출혈정황.결과 용약전환자AA-Ag위73.20％±7.32％,아사필림용약후AA-Ag위12.91％±5.43％,파동범위0.42％～30.50％,11.8％적환자용약후AA-Ag≥20％.용약전AA -Ag여용약후AA-Ag정정상관(r=0.493,P＜0.01),제사분위수조적치료후AA-Ag고우기타분위수조.≥80세조용약후AA-Ag위10.25％±4.68％,명현저우60～69세조화70～79세조.용약후AA-Ag저우하사분위수적환자재≥80세조(13례,38.2％)명현다우기타년령조[분별위11.1％ (3/27)화24.0％ (18/75),P균＜0.05].다인소분석표명,용약전AA-Ag(P =0.001)、년령≥80세(P =0.009)、급성관상동맥종합정(P=0.026)、당뇨병(P=0.017)균시용약후AA-Ag적독립예측인소.4례(2.9％)발생소화도출혈,기중3례용약후AA-Ag저우하사분위수.결론 노년환자적아사필림반응성개체차이대,용약전혈소판활성가예측아사필림반응성,고령환자대아사필림경민감.
Objective To explore clinical and laboratory factors associated aspirin response,and the association between gastrointestinal bleeding and aspirin response in aged patients.Methods A total of 136 patients aged 60 and over [ mean age (74.9 ±7.0)years] with ischemic heart disease and at high risk for ischemic heart disease were included.Arachidonic acid induced platelet aggregation (AA-Ag) was measured before and at 7th day after taking aspirin ( 100 mg/d).Patients were followed for 6 months and incidence of gastrointestinal bleeding was obtained.Results Post-treatment AA-Ag was significantly reduced compared to baseline ( 13.29％ ±5.52％ vs.73.20％ ±7.32％,P ＜0.05).A heterogeneous distributed post-treatment AA-Ag was observed ( range 0.42％ to 30.50％ ).Post-treatment AA-Ag was positively correlated with baseline AA-Ag ( r =0.493,P ＜ 0.01 ).The level of post-treatment AA-Ag was significantly higher in the fourth quartile group at baseline than in the others quartile groups at baseline.Patients aged 80 years and over had significantly lower post-treatment AA-Ag ( 10.25％ ±4.68％ ) compared with patients of 60 -69 years (13.96％ ±5.20％ ) and of 70 -79 years (13.73％ ±5.48％,all P＜0.01 ).The incidence of patients in the lowest quartile of post-treatment AA-Ag was significantly higher in patients ≥ 80 years (38.24％ ) than in patients of 60 -69 years ( 11.1％ ) and of 70 -79 years (24.0％).Multiple variable analysis revealed post-treatment AA-Ag was significantly influenced by baseline AA-Ag,≥ 80 years old,diabetes mellitus and acute coronary syndrome.We observed 4 ( 2.9％ ) mild gastrointestinal bleeding during follow up.Post-treatment AA-Ag was in the lowest quartile in 3 patients with mild gastrointestinal bleeding.Conclusions Increased baseline platelet reactivity as well as diabetes mellitus and acute coronary syndrome are associated with low aspirin response in the aged patients.Aspirin response is significantly higher in very old patients.