冠心病合并糖尿病患者联合抗血小板药物抵抗的相关研究  

Analysis of aspirin resistance and clopidogrel resistance in patients with coronary heart disease combind with diabetes mellitus

作　　者：王志军 张鹏宇 周建芝 刁增利 黄宇玲 刘铁楠 李海涛 WANG Zhijun ZHANG Pengyu ZHOU Jianzhi DIAO Zengli HUANG Yuling LIU Tienan LI Haitao(Department of Cardiology,The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, 063000, China University Hospital of North China University of Science and Technology)

机构地区：[1]华北理工大学附属医院心内科,河北唐山063000 [2]华北理工大学校医院内科

出　　处：《临床心血管病杂志》2016年第10期978-982,共5页Journal of Clinical Cardiology

基　　金：河北省卫生厅医学研究重点课题计划项目(No:20100474)

摘　　要：目的:分析冠心病(CHD)合并糖尿病(DM)患者阿司匹林抵抗(AR)及氯吡格雷抵抗(CR)的影响因素,评价AR、CR与主要不良心血管事件(MACE)的关系以及MACE的相关因素。方法:选择CHD患者270例,其中非DM患者136例(NDM组),DM患者134例(DM组),记录患者临床情况及心电图、超声心动图、冠脉造影等检查结果。检查血常规、凝血功能、生化指标。评价AR及CR。随访1年,记录患者MACE事件并分析其相关因素。结果:NDM组AR(33.8%︰62.7%,P<0.05)及CR(33.1%︰58.2%,P<0.05)发生率均显著低于DM组。NDM组无抵抗发生率显著高于DM组(54.4%︰22.4%,P<0.05),半抵抗(24.3%︰34.3%,P<0.05)和抵抗(21.3%︰44.3%,P<0.05)发生率显著低于DM组。无抵抗、半抵抗与抵抗患者hs-CRP、CK-MB、TG、TC、LDL-C、ApoA1、CR、UA、WBC计数、病变血管(处)、严重病变(处)等均差异有统计学意义(均P<0.05)。随访结果显示:DM组患者发生MACE事件44例(32.8%),NDM组发生MACE事件38例(27.9%)。Logistic分析显示,男性、心率、BMI、TG、LDL、双联抗血小板药物治疗抵抗是CHD合并DM患者发生MACE的影响因素。结论:CHD合并DM患者联合抗血小板治疗抵抗明显增高,药物抵抗与多种因素有关。发生药物抵抗患者MACE事件明显增加。Objective：To analysis influencing factors of aspirin resistance（AR）and clopidogrel resistance（CR）in patients with coronary heart disease（CHD）combined diabetes mellitus（DM）,to evaluate the relationship among AR,CR and major adverse cardiovascular events（MACE）and the relevant factor of MACE.Method：One-hundred and thirty-six CHD patients without DM（NDM group）and 134 CHD patients combined with DM were included.Clinical data about ECG,echocardiography,coronary angiography,blood count biochemical indicators were collected.After 1-year follow-up,MACE events were recorded and related factors were analyzed.Result：The incidences of AR（33.8%：62.7%,P〈0.05）and CR（33.1%：58.2%,P〈0.05）in NDM group were significantly lower than those in DM group.The incidence of no resistance in NDM group was significantly higher than that in DM group（54.4%：22.4%,P〈0.05）,and the incidences of semi resistance（24.3%：34.3%,P〈0.05）and resistance（21.3%：44.3%,P〈0.05）were significantly lower than those in DM group.There were significant differences in hs-CRP,CK-MB,TG,TC,,LDL-C,ApoA1,CR,UA,WBC,and pathological changes in the patients with non resistance,resistance,and resistance（all P〈0.05）.The follow-up results showed that：44cases（32.8%）of MACE occurred in DM group,38cases（27.9%）of MACE occurred in NDM group.Logistic analysis showed that male,heart rate,BMI,TG,LDL,dual antiplatelet therapy were resistance MACE factors in patients with CHD combined with DM.Conclusion：Drug resistance of dual antiplatelet therapy is significantly increased in patients with CHD combine with DM,and drug resistance is associated with a variety of factors.MACE events in patients with drug resistance are significantly increased.

关 键 词：冠心病 糖尿病 阿司匹林抵抗 氯吡格雷抵抗 

分 类 号：R541.4[医药卫生—心血管疾病]