Muir A R, McMullin M F, Patterson C, McKeown P P
Department of Medicine, Queen's University Belfast, Institute of Clinical Science, Grosvenor Road, Belfast BT12 6BJ, UK.
Heart. 2009 Aug;95(15):1225-9. doi: 10.1136/hrt.2008.150631. Epub 2008 Aug 12.
Laboratory tests including optical platelet aggregometry (OPA), platelet function analyser (PFA-100), and thromboxane B2 (TXB2) metabolite levels have been used to define aspirin resistance. This study characterised the prevalence of aspirin resistance in patients with ischaemic heart disease (IHD) and investigated the concordance and repeatability of these tests.
DESIGN, SETTING AND PATIENTS: Consecutive outpatients with stable IHD were enrolled. They were commenced on 150 mg aspirin daily (day 0) and had platelet function assessment (OPA and PFA-100) and quantitative analysis of serum/urine TXB2 at day > or =7 and then at a second visit approximately 2 weeks later.
We assessed the prevalence of aspirin resistance by each method, concordance between methods of measuring response to aspirin and association between time points to assess the predictability of response over time.
172 patients (62.7 (SD 8.7) years, 83.1% male) were recruited. At visits 1 and 2, respectively, 1.7% and 4.7% were aspirin resistant by OPA, whereas 22.1% and 20.3% were aspirin resistant by PFA-100. There were poor associations between PFA-100 and OPA, and between TXB2 metabolites and platelet function tests. OPA and PFA-100 results were poorly associated between visits (kappa = 0.16 and kappa = 0.42, respectively) as were TXB2 metabolites, suggesting that aspirin resistance is not predictable over time.
The prevalence of aspirin resistance is dependent on the method of testing. Response varies on a temporal basis, indicating that testing on a single occasion is inadequate to diagnose resistance or guide therapy in a clinical setting.
包括光学血小板聚集测定法（OPA）、血小板功能分析仪（PFA - 100）以及血栓素B2（TXB2）代谢物水平在内的实验室检测已被用于定义阿司匹林抵抗。本研究对缺血性心脏病（IHD）患者中阿司匹林抵抗的患病率进行了特征描述，并调查了这些检测的一致性和可重复性。
设计、研究地点与患者：纳入连续的稳定型IHD门诊患者。他们从每日服用150毫克阿司匹林开始（第0天），并在第≥7天以及大约2周后的第二次就诊时进行血小板功能评估（OPA和PFA - 100）以及血清/尿液TXB2的定量分析。
我们通过每种方法评估阿司匹林抵抗的患病率、测量对阿司匹林反应的方法之间的一致性以及各时间点之间的关联，以评估反应随时间的可预测性。
招募了172名患者（年龄62.7（标准差8.7）岁，83.1%为男性）。在第1次和第2次就诊时，分别有1.7%和4.7%的患者通过OPA检测显示阿司匹林抵抗，而通过PFA - 100检测显示阿司匹林抵抗的患者分别为22.1%和20.3%。PFA - 100与OPA之间以及TXB2代谢物与血小板功能检测之间的关联性较差。就诊之间OPA和PFA - 100的结果关联性较差（kappa值分别为0.16和0.42），TXB2代谢物的情况也是如此，这表明阿司匹林抵抗随时间不可预测。
阿司匹林抵抗的患病率取决于检测方法。反应随时间变化，这表明在临床环境中单次检测不足以诊断抵抗或指导治疗。
