老年2型糖尿病合并冠心病患者阿司匹林抵抗的危险因素分析

目的 研究老年T2DM合并冠心病患者对阿司匹林的反应性及其危险因素. 方法 选择我院老年科住院的T2DM合并冠心病患者147例,根据血栓弹力图（TEG）结果将其分为阿司匹林抵抗组（AR,抑制率≤50％）和阿司匹林非抵抗组（N-AR）,并分析两组临床数据. 结果 AR组30例,N-AR组117例.AR发生率为20％.AR组同型半胱氨酸（Hcy）、FPG、TG、LDL-C及HbA1c分别为（16.43±4.77）mmol/L,（7.73±0.16）mmol/L,（1.70±0.60） mmol/L,（2.60±0.55） mmol/L,（7.79±0.58）％,均明显高于N-AR组,而视黄醇结合蛋白（RBP）为（34.17±9.30） mmol/L,低于NAR组（P＜0.05）.Logistic回归分析结果显示,FPG、TC、LDL-C和Hcy是AR的影响因素,使患者AR的危险性分别提高1.9倍,0.1倍,13.1倍和1.1倍.血糖不达标者、糖尿病病程较长者AR发生率增高（P＜0.05）.结论 T2DM合并冠心病患者存在一定的AR现象,有效地控制血糖,减低血脂,降低Hcy,可降低AR发生率.

Analysis of fisk factors for aspirin resistance in type 2 diabetes with coronary heart disease in elderly patients

Objective To study the reactivity and the risk factors of aspirin resistanc （AR） in the elderly patients with type 2 diabetes plus coronary heart disease. Methods The 147 elderly hospitalized patients of type 2 diabetes with coronary heart disease were devided into AR group （inhibitory rate 50%） and NAR group according to thromhelastograph （TEG） results and the clinical data of two groups were analyzed. Results There were 30 patients in AR group and 117 patients in NAP, group. The incidence rate of aspirin resistance was 20%. The homocysteine level （Hcy）, FPG, TG, LDL-C and HbA1 c were higher in AR group than in NAR group[（16.48±4.77） mmol/L, （7.73±0.16） mmol/L, （1.70± 0.60） mmol/L, （2.60±0.55） mmol/L, （7.79±0.58）%, respectively], but retinol binding protein （RBP） was lower in AR group than in NAR group （P〈0.05） . Logistic regression analysis results showed that FPG,TG, LDL-C and Hcy were the impact factors of aspirin resistance, and made the risk of aspirin resistance enhanced by 1.9 times, 0, 1 times, 13.1 times, 1.1 times, respectively. The incidence rate of aspirin resistance was increased in patients with pathoglycemia and longer course of diabetes （P〈0.05）. Conclusion There exists certain aspirin resistance in elderly patients with type 2 diabetes plus coronary heart disease. If blood glucose is effectively controlled and blood lipid and Hcy are reduced effectively, the incidence of aspirin resistance would be decreased.