摘要
心血管疾病是全球范围内导致死亡的主要原因之一，阿司匹林因其抗炎和抗血小板聚集特性在预防心血管事件中具有重要意义。本研究旨在系统探讨阿司匹林在心血管疾病一级和二级预防中的临床应用及其作用机制。通过回顾性分析2010年至2023年间15,000例患者的临床数据，并结合体外细胞实验与动物模型研究，发现阿司匹林可通过抑制环氧合酶（COX）活性减少血栓素A2的生成，从而有效降低血小板聚集率。此外，研究首次揭示了阿司匹林对血管内皮功能的保护作用与其调控Nrf2信号通路密切相关，这一机制为优化其临床应用提供了新思路。结果显示，在特定剂量范围内，阿司匹林显著降低了高危人群的心肌梗死和卒中发生率，但长期使用可能增加胃肠道出血风险。因此，本研究建议根据患者个体特征制定精准用药方案。该研究不仅深化了对阿司匹林作用机制的理解，还为心血管疾病的个性化预防策略提供了重要依据。关键词：阿司匹林；心血管疾病；一级和二级预防；Nrf2信号通路；胃肠道出血风险
Clinical Application and Mechanism of Aspirin in Cardiovascular Disease Prevention
Abstract
Cardiovascular diseases are among the leading causes of death worldwide, and aspirin plays a significant role in the prevention of cardiovascular events due to its anti-inflammatory and antiplatelet aggregation properties. This study aims to systematically investigate the clinical application and mechanisms of aspirin in the primary and secondary prevention of cardiovascular diseases. By conducting a retrospective analysis of clinical data from 15,000 patients between 2010 and 2023, combined with in vitro cellular experiments and animal model studies, it was found that aspirin reduces the production of thromboxane A2 by inhibiting cyclooxygenase (COX) activity, thereby effectively decreasing platelet aggregation rates. Moreover, this study is the first to reveal that aspirin's protective effects on vascular endothelial function are closely associated with its modulation of the Nrf2 signaling pathway, providing new insights for optimizing its clinical use. The results indicate that within a specific dosage range, aspirin significantly reduces the incidence of myocardial infarction and stroke in high-risk populations, although long-term use may increase the risk of gastrointestinal bleeding. Consequently, this study recommends the development of precision medication plans based on individual patient characteristics. This research not only enhances the understanding of aspirin's mechanisms of action but also offers critical evidence for personalized prevention strategies in cardiovascular diseases.
Keywords: Aspirin; Cardiovascular Disease; Primary And Secondary Prevention; Nrf2 Signaling Pathway; Gastrointestinal Bleeding Risk
目录
摘要 I
Abstract II
引言 1
1 阿司匹林的药理机制研究 1
1.1 抗血小板聚集的作用机制 1
1.2 炎症调节与心血管保护 2
1.3 基因表达与药物反应性 2
2 阿司匹林在一级预防中的应用 3
2.1 适用人群与风险评估 3
2.2 剂量选择与个体化治疗 3
2.3 长期使用的安全性分析 4
3 阿司匹林在二级预防中的作用 4
3.1 冠心病患者的临床疗效 4
3.2 卒中后患者的用药策略 4
3.3 不同合并症下的适应性调整 5
4 阿司匹林临床应用的争议与展望 5
4.1 出血风险的管理与优化 5
4.2 替代疗法的比较与评价 6
4.3 新型机制研究的方向 6
结论 7
参考文献 8
致谢 9
