血糖控制对急性心肌梗死合并2型糖尿病患者阿司匹林反应性及预后的影响  

Clinical studies on the role of glycaemic control in Aspirin reactivity and prognosis of patients with type 2 diabetes mellitus and acute myocardial infarction

作　　者：庞工力 王敬萍[1] 柴晓红[1] 马秀瑞[1] 杨晋静[1] 魏红[1] 王宁[1] 王婧[1] 

机构地区：[1]山西医科大学第一临床医学院心内科,山西省太原市030001

出　　处：《中国心血管病研究》2015年第3期252-255,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 明确血糖控制对急性心肌梗死（AMI）合并2型糖尿病（T2DM）患者阿司匹林反应性的影响及对预后的判断价值.方法 选取2013年11月至2014年3月山西省心血管病医院冠心病重症监护室成功行PCI术的AMI合并T2DM患者97例,根据入院时糖化血红蛋白水平分为血糖控制良好组（52例）和血糖控制不良组（45例）.治疗第7天行血栓弹力图检测比较两组的阿司匹林抗血小板聚集抑制率,并观察两组患者出院后6个月内的主要不良心血管事件（MACE）有无差异.结果 ①血糖控制良好组花生四烯酸（AA）诱导的血小板聚集抑制率高于血糖控制不良组[（69.5±22.7）％比（52.5±22.5）％,P=0.005],血糖控制良好组阿司匹林反应低下的患者少于不良组（13例比21例,P=0.026）,差异有统计学意义.②6个月内随访结果显示,与血糖控制良好组比较,血糖控制不良组更易发生MACE事件（9例比3例,P=0.034）.③多因素Logistic回归分析表明,血糖控制不良和血小板聚集抑制率低下是AMI合并T2DM患者的独立预后指标.结论 血糖控制水平影响AMI患者阿司匹林反应性,同时血糖控制和AA诱导的血小板聚集抑制率对AMI合并T2DM患者预后判断有重要价值.Objective To study the effect of glycemic control on response to Aspirin in patients with type 2 diabetes mellitus （T2DM） and acute myocardial infarction （AMI）. Methods In total, from 2013 novenber to 2014 march 97 patients with T2DM and AMI were recruited who successfully for PCI treatment in the Coronary Care Unit Of Shanxi cardiovascular Hospital, Patients were divided according to glycemic control （HbAlc）： good〈 7% and suboptimal ≥ 7.0%. All patients taking Aspirin were investigate the platelet inhibition ratio by thromboe- lastography（TEG）. All enrolled patients were followed up for 6 months after discharged, and major adverse cardio- vascular evevts （MACE） were recorded. Results The platelet inhibition ratio was increased in patients with good glycemic control compared to patients with suboptimal control. Follow-up results show that the MACE occurred more in patients with suboptimal control. Conclusion An important relation exists between glycemic control and Aspirin reactivity in patients with AMI and T2DM. The glycemic control and platelet inhibition ratio may have a certain association with worse prognosis.

关 键 词：急性心肌梗死 糖尿病 阿司匹林 预后 

分 类 号：R542.22[医药卫生—心血管疾病]