血栓弹力图检测对糖尿病合并急性冠脉综合征老年患者的诊断意义  

Diagnostic significance of thromboelastography in elderly patients with diabetes and acute coronary syndrome

作　　者：许强[1] 

机构地区：[1]中国人民解放军总医院老年心血管病研究所,北京100853

出　　处：《中国急救复苏与灾害医学杂志》2013年第5期420-422,共3页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家自然科学基金面上项目：候选基因中罕见功能性变异型蓄积对中国患者人群华法林抗凝治疗剂量个体间差异影响的药物基因组学研究（30971259）

摘　　要：目的了解血栓弹力图检测对老年糖尿病患者合并急性冠脉综合征的鉴别诊断价值。方法连续选取接受氯吡格雷治疗的2型糖尿病合并冠心病老年住院患者313例，按照合并急性冠脉综合征与合并稳定性心绞痛分为观察组（178例）和对照组（135例），所有患者均进行血栓弹力图检测以获得花生四烯酸（AA）诱导与二磷酸腺苷（ADP）诱导的血小板抑制率，分析两组不同途径血小板抑制率的差异。然后分析血小板抑制率低于50％的患者罹患急性冠脉综合征的相对风险。结果观察组与对照组相比，AA诱导的血小板抑制率相差不大（D0．05），而观察组的ADP诱导的血小板抑制率为（44．1±26．1）％，显著低于对照组（66．9±29．2％，P〈0．01）。ADP诱导的血小板抑制率低于50％的患者发生ACS的几率明显增加（75％vs．46％，RR：1．60，P〈0．01）。结论血栓弹力图检测中ADP诱导的血小板抑制率偏低可能对糖尿病合并急性冠脉综合征老年患者具有鉴别诊断和风险分层的临床价值。Objective To evaluate the significance of thromboelastography （TEG） in the differential diagnosis of elderly patients with diabetes and acute coronary syndrome（ACS）. Methods 313 patients with type 2 diabetes meUitus and coronary heart disease who were on clopidogrel therapy, aged 65-90, 194 males and 119 females, were consecutively enrolled and were divided in2 groups according to subtypes of coronary heart disease, control group （n=135, with stable angina） and study group （n=178, with acute coronary syndrome）. All patients received TEG test to acquire adenosine diphosphateADP-induced and arachidonic acid （AA）-induced platelet inhibition ratios. The differences of AA and ADP induced platelet inhibition ratios were compared between these two groups. The relative risk of ACS in patients with low platelet inhibition ratio （〈50%） was analyzed. Results The ADP-induced platelet inhibition ratio of the study group was s （44.1 ± 26.1）% , significantly lower than that of the control group（66.9±29.2%, P〈0.01）. And there were no significant difference inthe AA-induced platelet inhibition ratio between these two groups （P〉0.05）. The patients who had low ADP-induced platelet inhibition ratio （〈50%） had higher relative risk of ACS compared with the patients with platelet inhibition ratio over 50% （75% vs. 46%, RR： 1.60, P〈0.01）. Conclusion Decreased ADP-induced platelet inhibition ratio acquired by TEG test may have clinical significance in differential diagnosis of patients with diabetes and acute coronary syndrome.

关 键 词：糖尿病 冠心病 老年 血栓弹力图 急性冠脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]