The Correlation And The Risk Factor Analysis Of The Large Artery Atherosclerosis Cerebral Infarction Patients With Aspirin Resistance And Recurrent Cerebral Infarction

Objective:To study the relationship between the occurrence of AR, ASR and LAACI recurrence,as well as the risk factor of AR,ASR, so as to provide a basis to prevent and reduce LAACI recurrence as well as providing help for the stair and secondary prevention to the cerebrovascular disease in clinic.Methods:Case-contrast study method, choosing 90 patients with confirmed LAACI neurology,ruling out previous aspirin allergies, abnormal liver function, the activity of the digestive tract ulcer,acute trauma and bleeding within two weeks, blood system diseases, etc.(1) 33 cases for more than 3 years without LAACI recurrence, 57 cases in 3 years with LAACI recurrence. All patients taking aspirin 100mg/d, at least more than 4 weeks. Using light transmission aggregometry(LTA) method to measure and record AR and ASR, as well as information of gender, age, drinking, smoking, taking drugs, with a combination of diseases and other clinical features and general situation, compared the incidence of AR and ASR between two groups, and investigated the relationship between AR, ASR and LAACI recurrence.(2) According to whether appeared the AR, ASR the 90 patients were divided into the AS for group of 41 cases and AR + ASR group of 49 cases,with additional to record of general dilettante blood tests, to explore the risk factors of AR, ASR.Results:(1) Two groups of patients in the history of hypertension, coronary heart disease,dyslipidemia etc, and the use of the antihypertensive drug, Hypoglycemic Agents,lipid-lowering drugs and smoking, alcohol or other indicators, there was no statistically significant difference(P>0.05), while age and gender difference was statisticallysignificant(P<0.05).(2) Through testing the platelet function with the method of LTA found that 90 patients were found occurred LAACI,21.1% of patients have LAACI AR,33.3% LAACI ASR, 54.4% of the patients with LAACI AR + ASR.(3) The rate of incidence of AR within LAACI recurrence group:42.9%, the incidence of ASR: 52.4%,the incidence of AR + ASR: 64.9%, the incidence of AR: LAACI did not relapse group16.0%, the incidence of ASR: 27.6%, the incidence of AR + ASR: 36.4%. Two comparance of AR, ASR, as well as the incidence of AR + ASR of the two groups, reveals that, the difference had statistical significance(P<0.05), AR,ASR play an important role in the occurrence of ASR in LAACI recurrence, after multiariable analysis, age, gender,AR, ASR are the independent risk factors for the recurrence of LAACI.The difference was statistically significant(P<0.05).(4)The risk of LAACI relapse in AR+ASR group is3.648 times higher than in AS group; every one year older, the risk of LAACI relapse rises to 1.075 times; the risk of LAACI relapse of men is 3.762 times higher than women.(5)LAACI patients who occurred AR, ASR or AS group in age, gender, history of hypertension, coronary heart disease and dyslipidemia as well as using antihypertensive drug, Hypoglycemic Agents, lipid-lowering drugs and smoking, alcohol or other indicators,there was no statistically significant difference(P>0.05), diabetes prevalence compared difference has statistically significant(P<0.05).(6) LAACI patients who occurred AR,ASR group compared with the AS group, homocysteine difference was statistically significant(P<0.05). High-sensitivity creactive protein, total cholesterol, triglyceride, low density lipoprotein cholesterol(ldl-c), high-density lipoprotein, apolipoprotein B and apolipoprotein B, red blood cell count, white blood cell count, platelet count, fasting glucose, and glycosylated hemoglobin, D dimer, fibrinogen, blood sedimentation difference had no statistical significance(P>0.05), after multiariable analysis,diabetes,homocysteine elevated are independent risk factors affecting happen AR, the difference was statistically significant(P<0.05).(7)When the illness state of diabetes mellitus are the same, homocysteine rises every 1 umol/L, the risk of asprin resistance occurrence rises to 1.068 times; when homocysteine are the same, the risk of asprin resistance occurrence of diabetes mellitus patients is 4.118 times higher than non-diabetes mellitus patients.Conclusions:(1) LAACI crowd has a widespread and multi-leveled aspirin resistance.(2) LAACI recurrence group, has a significantly higher incidence of AR, ASR, AR + ASR than the LAACI relapse-free group. AR, ASR played an important role in the LAACI recurrence.Adjusting the antiplatelet aggregation effect actively, which does have important significance in clinical for the people who has occurred AR or ASR but do not have LAACI recurrence.(3) In LAACI crowd, diabetes and elevated homocysteine are independent risk factors for AR. These indexes in the prevention of the stair and secondary patients with LAACI attention should be controlled.