应用血栓弹力图对糖尿病患者冠状动脉旁路移植术后阿司匹林抵抗的观察  

Observation of aspirin resistance based on TEG in patients with diabetes mellitus after coronary artery bypass graft

作　　者：崔华楠[1] 吴明营[1] 吴文波[1] 周自强[1] 王妍军[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,100730

出　　处：《北京医学》2015年第10期916-920,共5页Beijing Medical Journal

基　　金：北京市教委科技发展计划项目(KM201010025018)

摘　　要：目的探讨糖尿病(diabetes mellitus,DM)对非体外循环下冠状动脉旁路移植术(off-pump coronary ar-tery bypass,OPCAB)术后早期阿司匹林抵抗(aspirim resistance,AR)的影响。方法应用血栓弹力图(thromboelastog-raphy,TEG)评价OPCAB术后早期(14 d内)常规剂量阿司匹林(100 mg/d)治疗下花生四烯酸(arachidonic acid,AA)诱导血小板聚集的抑制率(inhibition induced by AA,INHAA),观察DM患者及非糖尿病(non-diabetes mellitus,NDM)患者术后阿司匹林抵抗AR的发生率。连续选取行OPCAB术合并DM患者15例(DM组);同期随机入选NDM患者15例(NDM组)。于术前阿司匹林停药前(Ta)、术后口服阿司匹林后6 h(T1)、术后5 d(T2)、术后14 d(T3)采血,使用TEG经行血小板检测。结果术后T1、T2时AR发生率DM组比NDM显著增加(60.0%vs.40.0%;46.7%vs.20.0%,P均<0.05);T3时两组差异无统计学意义(P>0.05)。结论 OPCAB术后早期DM患者AR发生率高于NDM患者,DM可能是OPCAB术后AR发生的高危因素。Objectives The aim of this study is to explore the effects of diabetes mellitus （DM） on postoperative AR of patients early after off-pump CABG （OPCAB） and provide evidences for the application of aspirin in those with DM and prevention for AR after CABG. Methods Fifteen consecutive patients with DM who had underwent OPCAB were prospectively enrolled （DM group）, while 15 non-DM patients who underwent OPCAB were randomly selected as the control group （NDM group）. Blood samples were collected in the following time points： 6 hours after taking the last dose of aspirin before surgery （Ta）, 6 hours after taking the first dose of aspirin after surgery （T1）, the 5th day （T2） and the 14th day （T3） after surgery. All patients received standard dose of aspirin （100mg/day）. For each patient, arachidonic acidinduced inhibition rate （INHAA） at each time points were calculated based on thrombelastography （TEG）. Results For each time point, INHAA was insignificantly different between the two groups; while the AR incidence in DM patients at both T1 and T2 were significantly higher than in those without DM. At T3, no significant difference was shown between the two groups with regard to AR incidence. Conclusion In those DM patients who underwent OPCAB, tend to have a higher incidence and longer lasting period of AR than non-DM patients. DM may be a strong predictor of AR incidence after OPCAB.

关 键 词：冠状动脉旁路移植术 糖尿病 抗血小板治疗 阿司匹林抵抗 血栓弹力图 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]