2型糖尿病对阿司匹林和氯吡格雷双联抗血小板药物治疗效应的分析

目的:本研究通过前瞻性连续入选在我院因稳定性冠心病行经皮冠状动脉介入治疗(PCI)的患者,分析探讨糖尿病对阿司匹林和氯吡格雷双联抗血小板药物效应的影响。方法:2008年8月至2011年11月前瞻性连续入选稳定性冠心病患者。入院后服用氯吡格雷前测定花生四烯酸(AA)诱导的血小板聚集率和基线二磷酸腺苷(ADP)诱导的血小板聚集率,之后给予氯吡格雷300 mg负荷量口服,继续服用氯吡格雷75 mg/d至1 d后,再次测定服用氯吡格雷后ADP诱导的血小板聚集率。结果:入选了355例稳定性冠心病患者,其中合并2型糖尿病103例,非糖尿病252例。阿司匹林抵抗的发生率18.6%,糖尿病组与非糖尿病组阿司匹林抵抗的发生率未见明显差异(20.4%vs.17.9%,P=0.578),将患者基线特征纳入Logistic回归模型进行校正后结果显示,糖尿病并未增高阿司匹林抵抗的风险(OR=1.3,95%CI=0.7～2.7,P=0.439)。氯吡格雷抵抗的发生率为20.8%;糖尿病组氯吡格雷抵抗的发生率明显高于非糖尿病组(33.0%vs.15.9%,P<0.001);Logistic回归校正后结果显示,糖尿病是氯吡格雷抵抗的独立危险因素(OR=5.7,95%CI=2.9～11.1,P<0.001)。结论:双联抗血小板药物基础上,糖尿病未增高阿司匹林抵抗的风险;但是糖尿病明显增高了氯吡格雷抵抗的风险。

The antiplatelet responsiveness on combining aspirin and clopidogrel treatment in patients with type 2 diabetes

Objective: In this study,we prospectively and included consecutive stabe coronary artery disease patient undergoing elective percutaneous coronary intervention(PCI)in our institution to evaluate diabetes on the antiplatelet effect of combining aspirin and clopidogrel.Methods: We prospectively included consecutive stabe coronary artery disease patient undergoing percutaneous coronary intervention(PCI) in our institution.Platelet aggregation induced by arachidonic acid(AA) and the baseline adenosine diphosphate(ADP)-induced platelet aggregation was measured before taking clopidogrel after admission.And ADP-induced platelet aggregation was measured again after administrating clopidogrel 300 mg loading dose and continuously taking clopidogrel 75 mg/d up to 1 d.Results: 355 patients with stabe coronary artery disease were included,and 103 patients and 252 patients were included respectively in type 2 diabetic group and nodiabetic group.The rate of aspirin resistance(AR) is 18.6% in total,and there is no significantly difference between diabetic group and nodiabetic group(20.4% vs.17.9%,P=0.578).After adjusted by Logistic regression analysis including the baseline characteristic,the results showed diabetes didn’t significantly increase the risk of AR(OR=1.3,95%CI=0.7~2.7,P=0.439).The prevalence of clopidogrel resistance was 20.8%.The rate of clopidogrel resistance in diabetic group was significantly higher than in nodiabetic group(33.0% vs.15.9%,P<0.001).After adjusted by Logistic regression analysis,the results showed diabetes(OR=5.7,95%CI=2.9~11.1,P<0.001) were the independent risk factors of clopidogrel resistance.Conclusion: Diabetes did not significantly influence the risk of AR on combining aspirin and clopidogrel treatment;but diabetes significantly increased the risk of clopidogrel resistance.