老年糖尿病患者应用阿司匹林反应性研究  

Aspirin response study in elderly patients with diabetes

作　　者：蔡凡[1] 王毅盟[1] 王红艳[1] 陈浩田[1] 杨蓉[1] 吴方[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院老年科,上海市200025

出　　处：《老年医学与保健》2013年第2期93-96,114,共5页Geriatrics & Health Care

基　　金：上海市科委基金资助项目（124119a6800）、上海市教委基金资助项目（11YZ57）

摘　　要：目的研究老年糖尿病患者应用阿司匹林的反应及影响因素。方法采用光学法血小板聚集，分别应用花生四烯酸（arachidonicacid，AA）、二磷酸腺苷（adenosinediphosphate，ADP）作为诱导剂检测199例老年糖尿病患者血小板功能；全自动生化仪检测空腹、餐后2h血糖、血脂、肾功能；高压液相法测定糖化血红蛋白指标。运用real—timePCR、WesternBlot检测循环血中单核细胞环氧化酶一2（cyclooxygenase-2，COX-2）mRNA、蛋白表达水平；同时检测人单核细胞（THP-1）在不同时间（12h、24h）和不同葡萄糖浓度（5．6mmol／L、11．1mmol／L、22．2mmol／L）情况下COX-2mRNA的表达量。结果非阿司匹林敏感（notaspirinsensitive，NAS）组空腹血糖、糖化血红蛋白水平高于敏感组；糖化血红蛋白未达标组NAS发生率高于达标组；糖尿病病程长的组NAS发生率更高。空腹血糖、糖化血红蛋白是NAS的相关危险因素。NAS组外周血单核细胞中COX-2mRNA表达量、蛋白表达率高于阿司匹林敏感组（aspirinsensitive，ASo葡萄糖刺激人单核细胞（THP-1）COX-2mRNA表达增加，且所用葡萄糖浓度越高、时间越长COX-2mRNA表达量越高。结论空腹血糖、糖化血红蛋白是老年糖尿病患者阿司匹林不敏感独立的危险因素。高糖刺激COX-2表达增加，这可能是糖尿病患者阿司匹林不敏感发生率增高的原因之一。Objective To study the response of aspirin and the impact factors in the elderly diabetic patients. Methods Platelet function was measured by the platelet aggregation test with two different inducers （AA and ADP） in 199 cases of elderly patients with diabetes. By using the automatic biochemical analyzer, we measured the fasting blood glucose, post- prandial blood glucose, blood lipid, renal function, and other relevant indicators. Also, we apply the high-pressure- liquid-method to determine the glycosylated hemoglobin. Real-time PCR and Western Blot were used to detect the COX-2 mRNA and the protein expression level in mononuclear cells in the Circulating blood respectively. By stimulating human monocytes （THP-1） in different glucose concentration （5.6 mmol/L, 11.1 mmol/L, 22.2 mmol/L） ~within different time period ~ （12 hours, 24 hours）, we employ real time PCR to detect COX-2 mRNA. Result Both the level of fasting blood glucose and glycosylated hemoglobin are higher in the not-aspirin-sensitive （NAS） group than those in the sensitive group. The incidence of NAS is higher in the glycosylated hemoglobin nonattainment group than that in the standard group. It is also higher in the longer duration of diabetes group than in the shorter group. Fasting blood glucose and glycosylated hemoglobin are two significant risk factors to NAS. The expression of COX-2 mRNA of peripheral blood mononuclear cells in the NAS group and its protein expression are significantly higher than the aspirin-sensitive （AS） group. Glucose can stimulate THP-1 cells to increase the expression of COX-2 mRNA. The higher concentration of glucose and the longer stimulating time we used, the higher level of COX-2 mRNA expression was found. Conclusion Fasting blood glucose and glycosylated hemoglobin are two independent risk factors to NAS in elderly patients with diabetes. Higher-glucose-inducing increases the expression of COX-2, which might be one of the reasons for the increase of NAS in the elderly diabetic patients.

关 键 词：阿司匹林抵抗 血糖 单核细胞环氧化酶-2 老年 

分 类 号：R587.105.3[医药卫生—内分泌]