冠心病并糖尿病患者氯吡格雷治疗后PTS 分子标志物变化及意义  

Changes and Significance of PTS Molecular Markers after Treatment of Clopidogrel in Coronary Heart Disease Patients Combined with Diabetes

作　　者：万妮娜[1] 马建林[2] 吴明[2] 马立宁[2] 李斌[2] 

机构地区：[1]南华大学,湖南衡阳421001 海南省人民医院心内科,海南海口 570311 [2]海南省人民医院心内科,海南海口570311

出　　处：《医学新知》2015年第1期24-27,共4页New Medicine

基　　金：海南省卫生厅基金资助课题

摘　　要：目的：观察冠心病（CAD）并2型糖尿病（NIDDM）患者经过血小板 ADP 受体拮抗剂治疗后血栓形成前状态（PTS）分子标志物的变化及意义。方法对36例稳定性心绞痛（SA）、38例不稳定性心绞痛（UA）、40例 UA 合并 NIDDM 患者的 PTS 分子标志物进行检测，均给予血小板 ADP 受体拮抗剂氯吡格雷75 mg/ d，10 d 后复查 PTS 分子标志物，同时测定有无氯吡格雷抵抗。结果①氯吡格雷治疗前，UA 患者，尤其合并 NIDDM 组体内存在更明显的 PTS 分子标志物变化。②氯吡格雷治疗后，三组患者的血栓前状态均明显改善。③114例中氯吡格雷抵抗者18例，无抵抗者96例。其中，无抵抗者药物治疗后 PTS 分子标志物有明显改善。氯吡格雷抵抗者治疗前后各种 PTS 分子标志物指标均无明显变化。结论冠心病并糖尿病患者体内PTS 较冠心病非糖尿病患者严重，UA 患者体内 PTS 较 SA 患者严重。采用氯吡格雷治疗可以干预各型冠心病患者的 PTS，但对氯吡格雷抵抗患者这种干预效果不佳，可能是这些患者预后不良的重要原因。Objective To observe the changes and significance of prethrombotic state（PTS）molecular markers after treatment of clopidogrel in coronary heart disease（CHD）patients combined with non - insulin dependent diabetes mellitus（NIDDM）. Methods PTS molecular markers were measured in 36 patients with stable angina（SA）,38 pa-tients with unstable angina（UA）,40 UA patients combined with NIDDM,who were given platelet ADP receptor antag-onist clopidogrel 75 mg/ d. PTS molecular markers were reexamined and clopidogrel resistance was measured 10 days later. Results ①There were more obvious changes of PTS molecular markers in patients with UA,especially in those combined with NIDDM before clopidogrel treatment. ②There were significant improvement of PTS molecular markers in patients in three groups after clopidogrel treatment. ③There were 18 cases with clopidogrel resistance and 96 cases without clopidogrel resistance in 114 cases. There were significant improvement of PTS in patients without clopidogrel resistance. However,there was no significant difference of PTS molecular markers before and after treatment in patients with clopidogrel resistance. Conclusion PTS in CHD patients combined with diabetes is more serious than CHD pa-tients without diabetes. PTS in patients with UA is more serious than that in patients with SA. PTS in patients with all types of CHD can be intervened by clopidogrel therapy. However,it is not effective in patients with clopidogrel resist-ance,which may be an important cause of poor prognosis in these patients.

关 键 词：冠心病 糖尿病 血栓形成前状态 ADP受体拮抗剂 干预 

分 类 号：R587.1[医药卫生—内分泌] R541.4[医药卫生—内科学]