Objective To investigate the incidence of clopidogrel resistance(CR)and adverse events after PCI in patients with type 2 diabetes mellitus(T2DM) complicated with acute coronary syndrome (ACS) after taking anti-platelet drugs.Methods 107 ACS patients undergoing percutaneous coronary intervention (PCI) according to whether combined with T2DM were randomly divided into diabetes and non diabetes groups.Thrombelastogram (TEG) was used to measure taking aspirin and clopidogrel for 24 hours after the ADP pathway of platelet inhibition ratio.Results The incidence of multivessel disease incidence and lesion complexity were higher than those of the non diabetes group of diabetic patients in the CR group (P<0.05).Diabetic subgroup analysis found: compared with that of normal group,the incidence of CR was higher in patients with glycosylated hemoglobin (P<0.05).The occurrence rate of adverse cardiovascular events was higher in diabetes group than that of non diabetic group (P<0.05).Conclusions CR and multivessel coronary disease incidence,severity is more complicated with diabetes ACS patients more easily,antiplatelet drugs in patients with diabetes and poor inhibitory effect in patients with recent poor glycemic control related.The incidence of adverse cardiovascular events in patients with CR after PCI is higher,and the prognosis is poor.%目的 探讨2型糖尿病(T2DM)合并急性冠脉综合征(ACS)患者规范服用抗血小板药物后氯吡格雷抵抗(CR)及PCI术后近期不良事件的发生情况.方法 接受经皮冠状动脉介入(PCI)治疗的107例ACS患者按是否合并T2DM随机分成糖尿病组与非糖尿病组,通过血栓弹力图(TEG)测定两组患者服用阿司匹林、氯吡格雷负荷量24 h后ADP途径的血小板抑制率;根据冠脉造影结果计算血管病变支数和Gensini评分.根据糖尿病组中患者入院糖化血红蛋白(HbA1c)正常或偏高进行亚组分析.电话随访患者PCI术后6个月,比较CR组与非CR组之间患者不良心血管事件的发生率.此外,对CR组中糖尿病与非糖尿病患者亚组分析,比较不良心血管事件发生率.结果 合并T2DM的ACS患者中13例(38.2%)出现CR,非糖尿病患者中11例(15.1%)出现CR,糖尿病组患者CR的发生率、多支病变发生率、病变复杂程度均高于非糖尿病组(P<0.05).糖尿病亚组分析发现,HbA1c偏高组相比正常组,患者CR发生率更高(P<0.05).CR组与非CR组相比,不良心血管事件发生率更高;CR组亚组分析发现,合并糖尿病的患者相比非糖尿病患者不良心血管事件发生率更高(P<0.05).结论 合并糖尿病的ACS患者更易出现CR,且冠脉多支病变发生率较高、病变程度更为复杂,糖尿病患者抗血小板药物抑制效果欠佳与患者近期血糖控制不佳相关.CR患者PCI术后近期心血管不良事件发生率较高,预后不良,合并糖尿病的CR患者易发生心血管不良事件.
展开▼
