«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2016年第4期

页码:

435-438

栏目:

临床研究

出版日期:

2016-04-01

文章信息/Info

Title:

Risk factors and impact of danshen compound dripping pill on aspirin resistance in patients with stable angina pectoris

作者:

陈思锐¹; 张利华¹; 刘 军¹; 任引刚¹; 康 黎¹; 牛晓琳²

（第四军医大学唐都医院：1.老年病科，2.心内科，陕西 西安 710038）

Author(s):

CHEN Si-rui¹;  ZHANG Li-hua¹;  LIU Jun¹;  REN Yin-gang¹;  KANG Li¹;  NIU Xiao-lin²

(1.Department of Geriatrics, 2.Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shaanxi, China)

关键词:

心绞痛; 稳定型; 阿司匹林抵抗; 相关因素; 复方丹参滴丸

Keywords:

stable angina pectoris;  aspirin resistance;  risk factor;  danshen compound dripping pill

分类号:

R541.4;R446.1

DOI:

-

文献标识码:

A

摘要:

目的 分析稳定型心绞痛(SAP)患者发生阿司匹林抵抗的相关因素，观察复方丹参滴丸联合阿司匹林对血小板聚集率的影响。方法 采用病例对照研究方法收集376例连续服用阿司匹林(100 mg/d) 4周以上的SAP患者，根据血栓弹力图检测结果将患者分为阿司匹林抵抗组(72例)和阿司匹林敏感组(304例)，比较组间各指标的差异。随后将阿司匹林抵抗组随机分为对照组（36例）和试药组（36例），对照组继续口服阿司匹林100 mg/d，试药组加服复方丹参滴丸10粒，3次/d。1个月后复查血小板聚集率,对结果进行统计分析。结果 阿司匹林抵抗组空腹血糖、C反应蛋白、低密度脂蛋白胆固醇显著高于阿司匹林敏感组。对照组复查血小板聚集率较前无显著差异〔(70±6)% vs.(71±4)%〕，试药组复查血小板聚集率较前显著下降〔(69±6)% vs.(44±5)%，P<0.05〕。结论 糖尿病、低密度脂蛋白胆固醇、C反应蛋白是SAP患者阿司匹林抵抗的相关因素。复方丹参滴丸在降低阿司匹林抵抗患者的血小板聚集率方面具有一定疗效。

Abstract:

AIM To assess the related risk factors for aspirin resistance (AR) in patients with stable angina pectoris (SAP) and to evaluate the impact of danshen compound dripping pill on AR. METHODSOne hundred and seventy-six SAP patients (65.9±7.4 years) who received daily aspirin therapy (≥100 mg) during 1 month were recruited. Effect of aspirin was assessed using thrombelastography (TEG) platelet mapping assay. Patients with AR (defined as platelet aggregation rate induced by AA≥50%) were randomly assigned to control group (n=36) treated with aspirin alone and observation group (n=36) treated with a combination of aspirin and danshen compund dripping pill. AA-induced platelet aggregation rates were measured 1 month after treatment and results were compared. RESULTSSeventy-two patients (19.1%) were aspirin resistant. Multivariate logistic regression analysis revealed that elevated fasting serum glucose level, C-reactive protein and low-density lipoprotein cholesterol were risk factors for AR as determined by TEG. In observation group, AA-induced platelet aggregation rate was significantly lower after 1 month treatment compared with that before treatment. CONCLUSIONA significant number of SAP patients are aspirin resistant. Fasting blood glucose level, C-reactive protein and low-density lipoprotein cholesterol are closely associated with AR in SAP patients. Danshen compound dripping pill has some anti-platelet effect in SAP patients with AR.

参考文献/References

[1]Tosco P,Lazzarato L.Mechanistic insights into cyclooxygenase irreversibleinactivation by aspirin[J].Chem Med Chem,2009,4(6):939-945.
[2]Snoep JD,Hovens MM,Eikenboom JC,et al.Association of laboratory--defined aspirin resistance with a higher risk of recurrent cardiovascular events:a systematic review and meta-analysis[J].Arch Intern Med,2007,167(15):1593-1599.
[3]吴 霖,焦 洁,茹蔡伟,等.阿司匹林抵抗试验在老年心血管高危患者中的临床价值[J].临床内科杂志,2012,29(11):753-756.
[4]Floyd CN,Ferro A.Mechanisms of aspirin resistance[J].Pharmacol Ther,2014,141(1):69-78.
[5]Liu XF,Cao J,Fan L,et al.Prevalence of and risk factors for aspirin resistance in elderly patients with coronary artery disease[J].J Geriatr Cardiol,2013,10(1):21-27.
[6]Kim JD,Park CY,Ahn KJ,et al.Non-HDL cholesterol is an independent risk factor for aspirinresistance in obese patients with type 2 diabetes[J].Atherosclerosis,2014,234(1):146-151.
[7]Vaturi M,Vaduganathan M,Bental T,et al.Relation of Aspirin Response to Age in Patients With Stable Coronary Artery Disease[J].The American Journal of Cardiology,2013,12(2):212-216.
[8]Lopez LR,Guyer KE,Torre IG,et al.Platelet thromboxane(11-dehydro-Thromboxane B2)and aspirin response in patients with diabetes and coronaryartery disease[J].World J Diabetes,2014,5(2):115-127.
[9]Tantry US,Bliden KP,Gurbel PA.Overestimation of platelet aspirin resistance detection by thrombelastograph platelet mapping and validation by conventional aggregometry using arachi-donic acid stimulation[J].J Am Coll Cardiol,2005,46(9):1705-1709.
[10]Ertugrul DT,Tutal E,Yildiz M,et al.Aspirin resistance is associated with glycemic control, the dose of aspirin, and obesity in type 2 diabetes mellitus[J].J Clin Endocrinol Metab,2010,95(6):2897-2901.
[11]Watala C,Pluta J,Golanski J,et al.Increased protein glycation in diabetes mellitus is associatedwith decreased aspirin-mediated protein acetylation and reduced sensitivity of blood platelets to aspirin[J].J Mol Med,2005,83(2):148-158.
[12]Riondino S,Trifirò E,Principessa L,et al.Lack of biological relevance of plateletcyclooxygenase-2 dependent thromboxaneA2 production[J].Thrombosis Research,2008,122(3):359-365.
[13]张浩文,柴营营,陈寒昱,等.阿司匹林抵抗机制研究进展[J].中国药科大学学报,2014,45(4):496-503.
[14]Acikel S,Sari M,Akdemir R.The relationship between acute coronary syndrome and inflammation：a case of acute myocardial infarction associated with coronary involvement of Sweet s syn-dreme[J].Blood Coagul Fibrinolysis,2010,21(7):703-706.
[15]孙根义,张 颖,吴 畏,等.复方丹参滴丸治疗冠心病阿司匹林抵抗214例临床疗效观察[J].世界中医药,2011,6(4):301-302.

备注/Memo

备注/Memo:

收稿日期：2015-11-02.
通讯作者：张利华，主任医师，主要从事高血压病和冠状动脉介入治疗研究 Email:zlh1204@sohu.com
作者简介：陈思锐，硕士生 Email：chenthree19@sina.com

常用功能

更新日期/Last Update: 2016-04-01