氯吡格雷抵抗与老年代谢综合征患者体质指数及胰岛素抵抗的临床研究

目的本研究探讨“氯吡格雷抵抗”现象与老年代谢综合征患者体质指数（BMI）与胰岛素抵抗的临床意义。方法选取90例诊断为代谢综合征的老年住院患者，根据BMI的不同分为肥胖组（BMI〉28）、超重组（BMI24—28）、标准组（BMI〈24），每组30例，3组均给予氯吡格雷75mg／d治疗，以5μmol二磷酸腺苷（ADP）作为血小板聚集的激动剂，测定每组的HOMA指数及治疗前后血小板聚集率％的绝对差值（A聚集率），以△聚集率〈10％作为氯吡格雷抵抗阳性标准。结果90例患者中，发现△聚集率〈10％者13例（14．4％），肥胖组△聚集率较标准组降低。肥胖组氯吡格雷抵抗发生率为30％，超重组为10％、标准组为3．3％，三组间差异有统计学意义（P〈0．05）；且在肥胖组，HOMA-指数较标准组明硅增加（P〈0．05），结论老年代谢综合征患者中存在氯毗格雷抵抗现象，且与体质指数与胰岛素抵抗相关。

A clinical study on relationship between Clopidogrel resistance and body mass index and insulin resistance in elderly patients with metabolic syndrome

Objective To explore the relationship between Clopidogrel resistance and body mass index （BMI） and insulin resistance in elderly patients with metabolic syndrome, and discuss its clinical significance. Methods 90 elderly inpatients with metabolic syndrome were equally divided into three groups： obesity （BMI 〉 28）, overweight （ BM124-28 ） and control （BMI 〈 24） according to their BMI. All patients were treated with clopidogrel 75mg per day. The HOMA index and the absolute difference △aggregation rate] in the pre- and post-treatment platelet aggregation rate %] were measured with 5μmol adenosine diphosphate （ADP） as platelet aggregation agonist, and △ aggregation rate 〈 10% was used as the positive standard of clopidogrel resistance. Results Of the 90 subjects, △ aggregation rate was 〈 10% in 13 patients. A aggregation rate was lower in the obesity group than that in the control. The incidence of clopidogrel resistance in obesity, overweight and control were 30%, 10% and 3.3% respectively, the difference being statistically significant between the three groups （P〈0.05）. HOMA-index was higher in obesity group than that in control （P〈0.05）. Conclusions Clopidogrel resistance exists in elderly patients with metabolic syndrome, and is correlated with BMI and insulin resistance.