合并糖尿病的冠心病患者PCI治疗后氯吡格雷抵抗的影响因素

目的探讨合并糖尿病的冠状动脉粥样硬化性心脏病（冠心病）患者经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗后氯吡格雷抵抗的影响因素。方法159例行PCI治疗的冠心病患者，其中糖尿病患者56例，非糖尿病患者103例，术前予氯吡格雷300mg负荷剂量治疗，术后予75mg／d持续治疗。测其服药前、术后24h和术后5d以5μmol／L的二磷酸腺苷诱导的血小板最大聚集率。以血小板聚集抑制率≤10％定义为氯吡格雷抵抗。比较两组临床基线资料、相关常规检查、手术资料。Logistic回归分析糖尿病患者氯吡格雷抵抗的独立危险因素。结果糖尿病组发生氯吡格雷抵抗的比例为48．2％，显著高于非糖尿病组的20．4％，差异有统计学意义（P〈0．05）。糖尿病组三酰甘油浓度显著高于非糖尿病组，差异有统计学意义（P〈0．05）。两组其他基线资料比较，差异无统计学意义（P〉0．05）。Logistic回归分析结果显示糖尿病史（年）（β=0．243，OR=1．184，P=0．028）是糖尿病患者氯吡格雷抵抗的独立危险因素。结论合并糖尿病的冠心病患者存在更高的氯吡格雷抵抗比例。糖尿病史（年）是糖尿病患者PCI治疗后发生氯吡格雷抵抗的独立危险因素。

Influential factors of clopidogrei resistance in patients with diabetes and coronary heart disease after percutaneous coronary intervention

Objectives To discuss the influential factors of clopidogrel resistance in patients with diabetes and coronary heart disease who received percutaneous coronary interventions （PCI）. Methods A total of 159 coronary heart disease patients received PCI were enrolled （56 diabetic and 103 nondiabetic patients）. Clopidogrel of 300 mg loading dose and 75 mg/d ongoing dose was administered before and after PCI. The 5 μmol/L adenosine diphosphate （ADP）-induced maximum platelet aggregation rates （MPARs） were tested before administration as well as 24 h and 5 d after PCI. MPAR ≤ 10% was defiend as clopidogrel resistance. The basic clinical data, related routine examination results and PCI characteristics were compared between the two groups. Independent risk factors of clopidogrel resistance were explored by Logistic regression analysis. Results The ratio of clopidogrel resistance was much higher in diabetic patients than that in nondiabetic patients （48.2% vs. 20.4%, P〈0.05）. There was no significant difference in basic clinical data and related routine examination results between the two groups （P〉0.05） except triglyceride which was obviously higher in diabetic patients （P〈0.05）. Logistic regression analysis revealed that history of diabetes was the independent risk factor of clopidogrel resistance in diabetic patients （β=0.243, OR=1.184, P=0.028）. Conclusions Diabetic patients with coronary heart disease undergoing PCI have a higher ratio of elopidogrel resistance compared with nondiabetic patients. History of diabetes is the independent risk factor of clopidogrel resistance in diabetic patients with coronary heart disease after PCI.