稳定性心绞痛合并糖尿病患者的血栓弹力图检测结果分析  

Analysis of Platelet Inhibition Rate in Patients With Stable Angina Pectoris Combining Diabetes Mellitus

作　　者：张龙[1] 钱海燕[2] 武德巍 郑磊[2] 张丽[2] 俞梦越[2] 

机构地区：[1]首都医科大学潞河教学医院心内科,北京市101100 [2]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心内科,北京市100037

出　　处：《中国循环杂志》2014年第11期875-878,共4页Chinese Circulation Journal

摘　　要：目的:分析合并2型糖尿病的稳定性心绞痛患者血栓弹力图检测结果。方法:随机抽取阜外心血管病医院2012-01至2013-06行冠状动脉造影并置入支架的稳定性心绞痛患者360例,按照是否合并2型糖尿病分为糖尿病组(n=109)和非糖尿病组(n=251),两组患者经常规术前检查、药物治疗和冠状动脉支架置入,入院后行常规检查及血栓弹力图检测。分析血栓弹力图各指标在两组间的差异。结果 :糖尿病组年龄、男性占比例、高血压病史占比例、高脂血症占比例和高敏C反应蛋白显著高于非糖尿病组(P<0.05),单因素回归分析显示,糖尿病与二磷酸腺苷抑制率显著相关(r=0.977,P=0.0001),与花生四烯酸抑制率相关性不显著(r=0.245,P=0.069);多因素回归分析显示,在控制上述组间有统计学差异的各因素之后,糖尿病与二磷酸腺苷抑制率仍显著相关(r=0.862,P=0.0001)。两组患者的血栓弹力图主要参数,包括R值、K值、α角和Ma值均有显著统计学差异(P<0.05);花生四烯酸抑制率在两组间无显著差异(P=0.057),而二磷酸腺苷抑制率在两组有显著统计学差异(P=0.0001);且糖尿病组氯吡格雷抵抗的发生率显著高于非糖尿病组(34.7%vs 16.2%,P=0.001)。结论 :合并糖尿病的稳定性心绞痛患者呈现高凝状态,且氯吡格雷抵抗发生率高,提示冠状动脉介入术后需要加强抗血小板治疗以减少心血管事件。Objective： To analyze the thromboelastography （TEG） outcomes in patients with stable angina pectoris （SAP） combining diabetes mellitus （DM）. 〈br〉 Methods： A total of 360 SAP patients treated in our hospital by percutaneous coronary intervention （PCI） from 2012-01 to 2013-06 were randomized into 2 groups：SAP＋DM group, n=109 and SAP-DM group, n=251. Routine clinical examination and TEG test were performed and compared between 2 groups. 〈br〉 Results： Compared with SAP-DM group, SAP＋DM group showed the higher ratios of male gender, history of hypertension, hyperlipidemia and higher level of hs-CRP, all P〈0.05. Single regression analysis indicated that DM was related to adenosine diphosphate （ADP） inhibition rate （r=0.977, P=0.0001）, not related to arachidonic acid （AA） inhibition rate （r=0.245, P=0.069）. Multi regression analysis presented that with controlled relevant factors, DM was still related to ADP inhibition rate （r=0.862, P=0.0001）. The major TEG parameters as R value, K value,α-angle and MA value were obviously different between 2 groups, P〈0.05, while the AA inhibition rate was similar, P=0.057. ADP inhibition rate was different between 2 groups, P=0.0001. The incidence of clopidogrel resistance was higher in SAP＋DM group than that in SAP-DM group （34.7%vs 16.2%, P=0.001）. 〈br〉 Conclusion： The SAP patients combining DM were at hyper-coagulation status with higher incidence of clopidogrel resistance, who needed intensive post-operative anti-platelet therapy.

关 键 词：稳定性心绞痛 糖尿病 血栓弹力图 花生四烯酸抑制率 二磷酸腺苷抑制率 

分 类 号：R541[医药卫生—心血管疾病]