Li Xiaoli, Fan Li, Cao Jian, Wang Qiang, Liu Lin, Hu Guoliang, Hu Yixin, Wang Yazhen, Wu Ruojun
First Department of Geriatric Cardiology of South Building, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 Apr;37(4):338-42. doi: 10.3969/j.issn.1672-7347.2012.04.003.
To evaluate correlation between and agreement in light transmittance aggregation (LTA) and thromboelastography (TEG) in laboratory diagnosing aspirin resistance (AR), and to determine the prevalence of AR in old patients.
Patients in the Wanshoulu District of Beijing with ischemic atherothrombotic diseases were recruited. Inclusion criteria were age ≥ 65 years, and having received regular aspirin therapy (75-100 mg daily) for at least 4 weeks. On the basis of LTA assay, the definition of AR was taken as aggregation of ≥ 20% with AA (arachidonic acid), and of ≥ 70% with ADP (adenosine diphosphate). Aspirin-sensitivity was indicated by the absence of either of these criteria; aspirinsensitivity was indicated as both criteria being met. The definition of AR by TEG is ≥ 50% via AA-induced whole blood aggregation.
There were 13.69% prevalence of aspirin resistance for LTA using AA as the agonist, 30.16% prevalence of aspirin resistance for LTA using ADP as the agonist, and 23.67% prevalence of aspirin resistance for TEG using AA as the agonist. Results from these tests showed poor agreement (Kappa<0.4). However, by the method of LTA using AA and ADP as the agonists, prevalence of AR was 8.35%. By methods of AA-induced LTA and AA-induced TEG, prevalence of AR was 8.82%. Results from these two latter methods showed good agreement (Kappa = 0.793).
Combined methods, as described here, have good correlation and agreement in the assays of AR, and the results with them represent a realistic measure of the prevalence of AR. Prevalence of AR of elderly patients from Wanshoulu district of Beijing is about 9%.
评估透光率聚集法（LTA）和血栓弹力图（TEG）在实验室诊断阿司匹林抵抗（AR）中的相关性和一致性，并确定老年患者中AR的患病率。
招募北京万寿路地区患有缺血性动脉粥样硬化血栓形成疾病的患者。纳入标准为年龄≥65岁，且接受常规阿司匹林治疗（每日75 - 100mg）至少4周。基于LTA检测，AR的定义为花生四烯酸（AA）诱导的聚集率≥20%，二磷酸腺苷（ADP）诱导的聚集率≥70%。若不满足上述任何一条标准则表明阿司匹林敏感；两条标准均满足则表明阿司匹林敏感。TEG对AR的定义为AA诱导的全血聚集率≥50%。
以AA为激动剂时，LTA法检测阿司匹林抵抗的患病率为13.69%；以ADP为激动剂时，LTA法检测阿司匹林抵抗的患病率为30.16%；以AA为激动剂时，TEG法检测阿司匹林抵抗的患病率为23.67%。这些检测结果显示一致性较差（Kappa<0.4）。然而，采用以AA和ADP为激动剂的LTA法时，AR的患病率为8.35%。采用AA诱导的LTA法和AA诱导的TEG法时，AR的患病率为8.82%。后两种方法的结果显示一致性良好（Kappa = 0.793）。
本文所述的联合方法在AR检测中具有良好的相关性和一致性，其结果代表了AR患病率的实际测量值。北京万寿路地区老年患者的AR患病率约为9%。
