糖尿病合并冠心病老年患者氯吡格雷抵抗的危险因素分析

目的：分析2型糖尿病合并冠心病老年患者氯吡格雷抵抗发生情况及其危险因素。方法选择在重庆北部新区第一人民医院住院接受氯吡格雷治疗的2型糖尿病合并冠心病老年患者315例，服用氯吡格雷24 h后进行血小板聚集抑制率（△A ）检测，△A＞10％者为对照组（196例），△A≤10％者为观察组（119例）。观察两组心血管病危险因素，糖、脂代谢及炎症指标水平差异。结果与对照组比较，观察组性别、年龄、吸烟史、高血压发病率、高脂血症发病率、体质量指数及三酰甘油、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白水平等临床资料均差异无统计学意义（P＞0．05）；观察组超敏C反应蛋白以及空腹血糖、糖化血清蛋白水平明显增高，高密度脂蛋白胆固醇（HDL-C）水平明显偏低（P＜0．01）。结论糖尿病合并冠心病老年患者明显存在氯吡格雷抵抗现象，超敏C反应蛋白及空腹血糖、糖化血清蛋白水平增高而HDL-C水平降低，提示患者氯吡格雷抵抗风险可能增加。

Analysis of risk factors of clopidogrel resistance in elderly patients combined with diabetes mellitus and coronary heart disease

Objective To analyze the characteristics and risk factors of clopidogrel resistance in elderly hospi-talized patients combined with type 2 diabetes mellitus （T2DM ） and coronary heart disease （CHD） .Methods A to-tal of 315 cases were divided into control group （n=196） ,with the platelet aggregation inhibition rate （△A） detected 24 hours after taking clopidogrel more than 10% ,and observation group with △A not more than 10% （n=119） . Retrospectively analysis of the differences of cardiovascular disease risk factors ,blood sugar ,lipid metabolism and in-flammation index level between the two groups were performed .Results Compared with control group ,there were no significant statistically difference in sex ,ages ,body mass index （BMI） ,smoking history ,incidence of hypertension and hyperlipidemia ,and levels of triacylglycerol ,total cholesterol ,low density lipoprotein cholesterol and glycated hemo-globin in observation group （P〉0 .05） .Levels of hypersensitive C-reactive protein ,fasting glucose and glycosylated serum protein were significantly higher in observation group ,but level of high-density lipoprotein cholesterol was sig-nificantly lower （P〈 0 .01） ,compared with control group .Conclusion Clopidogrel resistance might be obvious in elderly patients combined with T2DM and CHD ,and the risk factors could include increased levels of hypersensitive C-reactive protein ,fasting glucose ,glycosylated serum protein ,and decreased level of high-density lipoprotein choles-terol .