慢性肾衰竭患者的阿司匹林抵抗。

Aspirin resistance in patients with chronic renal failure.

机构信息

Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.

出版信息

J Nephrol. 2011 Sep-Oct;24(5):636-46. doi: 10.5301/JN.2011.6259.

DOI:10.5301/JN.2011.6259

PMID:21279952

Abstract

BACKGROUND

Chronic renal failure (CRF) is associated with increased risk of cardiovascular morbidity and mortality. Aspirin resistance worsens clinical prognosis. The aim of this study was to explore the prevalence of aspirin resistance in CRF.

METHODS

Two hundred and forty-five CRF patients (115 patients undergoing chronic hemodialysis and 130 patients with stage 3-4 chronic kidney disease [CKD]) and 130 patients with normal renal functions (control group) were consecutively recruited. All subjects were taking aspirin regularly. Aspirin responsiveness was determined by Ultegra Rapid Platelet Function Assay-ASA (VerifyNow Aspirin). Aspirin resistance was defined as aspirin reaction unit (ARU) =550.

RESULTS

Aspirin resistance was detected in 53 patients undergoing hemodialysis, 32 patients with stage 3-4 CKD and 22 controls. The frequency of aspirin resistance was significantly higher in the CRF group compared with controls (34.7% vs. 16.9%, p<0.001) and in hemodialysis patients (46.1%) compared with stage 3-4 CKD patients (24.6%, p<0.001) and controls (16.9%, p<0.001). Multivariate analysis revealed female sex (odds ratio [OR] = 2.201; 95% confidence interval [95% CI], 1.173-4.129; p=0.014), hemodialysis (OR=3.636; 95%CI, 1.313-10.066; p=0.013) and HDL cholesterol (OR=0.974; 95% CI, 0.950-0.999; p=0.043) as independent predictors of aspirin resistance in this cohort of patients.

CONCLUSION

Patients with CRF have higher frequency of aspirin resistance. This might further increase the risk of cardiovascular morbidity and mortality in these patients.

摘要

背景

慢性肾衰竭（CRF）与心血管发病率和死亡率增加相关。阿司匹林抵抗会使临床预后恶化。本研究旨在探讨 CRF 患者中阿司匹林抵抗的发生率。

方法

连续招募了 245 例 CRF 患者（115 例接受慢性血液透析，130 例 3-4 期慢性肾脏病[CKD]）和 130 例肾功能正常的患者（对照组）。所有患者均常规服用阿司匹林。通过 Ultegra Rapid Platelet Function Assay-ASA（VerifyNow Aspirin）测定阿司匹林反应性。将阿司匹林反应单位（ARU）=550 定义为阿司匹林抵抗。

结果

在血液透析患者中发现 53 例、3-4 期 CKD 患者中发现 32 例和对照组中发现 22 例存在阿司匹林抵抗。与对照组（16.9%，p<0.001）和 3-4 期 CKD 患者（24.6%，p<0.001）相比，CRF 组的阿司匹林抵抗发生率显著更高（34.7%，p<0.001），血液透析患者的发生率（46.1%，p<0.001）也显著更高。多变量分析显示女性（比值比[OR] = 2.201；95%置信区间[95%CI]，1.173-4.129；p=0.014）、血液透析（OR=3.636；95%CI，1.313-10.066；p=0.013）和高密度脂蛋白胆固醇（OR=0.974；95%CI，0.950-0.999；p=0.043）是该患者队列中阿司匹林抵抗的独立预测因素。