阿司匹林抵抗与冠心病并2型糖尿病患者主要不良心血管事件的相关性分析  

Correlation between Aspirin Resistance and Major Adverse Cardiovascular Events in Coronary Heart Disease Patients Complicated with Type 2 Diabetes Mellitus

作　　者：王玉华[1] 夏静雯[1] 葛俊炜 

机构地区：[1]上海市第七人民医院心血管内科,200137

出　　处：《实用心脑肺血管病杂志》2016年第7期24-27,35,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨阿司匹林抵抗（AR）与冠心病并2型糖尿病（T2DM）患者主要不良心血管事件（MACE）的相关性。方法选取2013年1月—2014年6月上海市第七人民医院心血管内科收治的冠心病并T2DM患者124例,入院后均在常规治疗的基础上服用阿司匹林,首次剂量300 mg,而后100 mg/d继续维持治疗。分别于给药前、给药后7~10 d检测血小板聚集率,根据AR情况将所有患者分为AR组31例和阿司匹林敏感（AS）组93例,记录患者的性别、年龄、个人史（饮酒、吸烟等）、既住史（高血压等）、体质指数、血压（收缩压、舒张压）、空腹血糖（FBG）、血脂指标〔总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）〕、凝血功能、C反应蛋白、糖化血红蛋白（HbA_（1c））水平等。随访6~12个月,分析MACE发生情况及AR与冠心病并T2DM患者MACE的相关性。结果 AR组患者MACE发生率高于AS组（P〈0.05）;其中AR组急性冠脉综合征、心肌梗死发生率高于AS组（P〈0.05）,而两组患者心源性死亡、心房颤动发生率比较,差异无统计学意义（P〉0.05）。随访期间40例患者出现MACE（MACE组）,84例患者未出现MACE（非MACE组）。MACE组和非MACE组患者性别、冠心病病程、T2DM病程、吸烟率、饮酒率、高血压发生率、TC、HDL-C、C反应蛋白比较,差异无统计学意义（P〉0.05）;MACE组患者年龄、存在AR者所占比例高于非MACE组,体质指数、收缩压、舒张压、TG、LDL-C、FBG、HbA_（1c）低于非MACE组（P〈0.05）。多因素logistic回归分析结果显示,年龄〔OR=20.328,95% CI（1.875,278.543）〕、收缩压〔OR=5.736,95%CI（2.457,21.035）〕、LDL-C〔OR=12.244,95% CI（1.057,28.587）〕、FBG〔OR=6.024,95% CI（2.003,22.567）〕、HbA_（1c）〔OR=2.254,95%CI（1.154,4.675）〕及AR〔OR=21.658,95% CI（3.032,200.457）〕与MACE的发生有回归关系（P〈0.05）Objective To investigate the correlation between aspirin resistance and major adverse cardiovascularevents （ MACE） in coronary heart disease patients complicated with diabetes mellitus （ T2DM） . Methods From January 2013to June 2014, a total of 124 coronary heart disease patients complicated with T2DM were selected in the Department ofCardiovascular Medicine, the Seventh People＇s Hospital of Shanghai, all of them received conventional treatment and aspirin（300 mg as the first dose, 100 mg per day as the maintenance dose）. Platelet aggregation rate was detected before treatment and within 7 to 10 days after treatment, all of the patients were divided into A group （ with aspirin resistance, n = 31） and B group（ with aspirin sensitivity, n =93） according to the detection result of platelet aggregation rate; gender, age, personal history（ including drinking, smoking and so o n ） , medical history （ including hypertension and so o n ） , BMI, blood pressure（including SBP and DBP） , FBG, blood lipids index （including TC, TG, LDL-C and HDL-C） , coagulation function, CRPand HbAlc were recorded. All of the patients were followed up for 6 to 12 months, incidence of MACE and influencing factors ofMACE in coronary heart disease patients complicated with T2DM were analyzed. Results The incidence of MACE of A groupwas statisticlly significantly higher than that of B group （ P 〈 0. 05 ） ; thereinto the incidence of acute coronary syndrome andmyocardial infarction of A group was statistically significantly higher than that of B group, respectively （ P 〈 0. 05 ） , while nostatistically significant differences of incidence of cardiac death or atrial fibrillation was found between A group and B group （ P 〉0. 0 5 ）. Of the 124 patients, 40 cases occurred MACE during the follow - up were served as C group, other 84 patients did notoccurred MACE were served as D group. No statistically significant differences of gender, course of coronary heart disease, courseof T2DM, smoking rat

关 键 词：冠心病 糖尿病 2型 阿司匹林抵抗 主要不良心血管事件 

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