应用血栓弹力图评价糖尿病对急性冠状动脉综合征患者血小板抑制率的影响

目的 了解糖尿病对双联抗血小板治疗的急性冠状动脉综合征患者血小板抑制率的影响.方法 选择自2011年12月至2012年7月在我院住院的急性冠状动脉综合征患者90例为研究对象.入院后均给予标准双联抗血小板治疗,并于入院即刻及入院第7天应用血栓弹力图仪测定花生四烯酸（AA）和二磷酸腺苷（ADP）诱导的血小板抑制率,根据是否合并糖尿病,将患者分为糖尿病组和非糖尿病组,比较两组患者AA和ADP诱导的血小板抑制率的差异及血糖、糖化血红蛋白与血小板抑制率的相关性.结果 90例急性冠状动脉综合征患者中合并糖尿病患者38例,非糖尿病患者52例,入院第7天,前者AA诱导的血小板抑制率为74.2％ ±20.2％,ADP诱导的血小板抑制率为42.6％±18.5％,后者分别为78.5％±21.3％和60.7％±27.5％,两组患者之间AA抑制率差异无统计学意义,而ADP抑制率在糖尿病患者中低于非糖尿病患者（P＜0.05）.糖化血红蛋白与ADP诱导的血小板抑制率呈明显负相关（r=-0.286,P＜0.05）,与AA抑制率无明显相关性.空腹血糖与AA和ADP抑制率均无明显相关性.结论 糖尿病患者ADP诱导的血小板抑制率降低,且与糖化血红蛋白呈负相关,而AA诱导的血小板抑制率无明显变化.

Effect of diabetes mellitus on platelets inhibition ratio evaluated by thrombelastogram in patients with acute coronary syndrome

Objective To investigate the effect of diabetes mellitus on platelet inhibition ratio in patients with acute coronary syndrome underwent dual antiplatelet therapy.Methods A total of 90 inpatients with acute coronary syndrome were recruited from December 2011 to July 2012.The standard antiplatelet therapy,immediately 300 mg aspirin and 300 mg clopidogrel followed by 100 mg aspirin and 75 mg clopidogrel per day was offered after admission.Platelet inhibition ratio induced by arachidonic acid （AA） and adenosine diphosphate （ADP） was tested by thrombelastogram at admission and after 7 days.The patients were divided into two groups：diabetes group and non-diabetes group based on diabetes history.The AA and ADP induced platelet inhibition ratios were compared.The relationships between platelet inhibition ratios and fasting glucose and HbA1c were analyzed.Results There were 38 patients in diabetic group and 52 in non-diabetic group.7 days after admission the AA-induced platelet inhibition ratio was 74.2% ± 20.2%,and ADP-induced platelet inhibition ratio was 42.6% ± 18.5% in diabetic group,and 78.5% ± 21.3% and 60.7% ±27.5% in non-diabetic group respectively.There was no obviously difference between AA-induced platelet inhibition ratio in two groups,but ADP-induced platelet inhibition ratio was lower in diabetic group than that in non-diabetic group （P 〈 0.05）.There was significant negative relationship between HbA1c and ADP-induced platelet inhibition ratio （r =-0.286,P 〈 0.05）.Fasting glucose is not related with AA-and ADP-induced platelet inhibition ratio.Conclusions ADP-induced platelet inhibition ratio is decreased in diabetic patients,and is negatively related with HbA1c.Diabetes mellitus has less effect on AA-induced platelet inhibition ratio.