目的:探讨阿司匹林分别联合氯吡格雷与替格瑞洛对急性冠状动脉综合征(ACS)合并2型糖尿病(T2DM)患者经皮冠状动脉介入(PCI)术后残余血小板高反应性、主要心血管不良事件(MACE)及出血事件风险的影响.方法:研究对象选取ACS合并T2DM患者共120例,根据抗血小板方案不同分为对照组(63例)和观察组(57例),在阿司匹林基础上分别加用氯吡格雷与替格瑞洛治疗,比较两组患者残余血小板高反应性发生率,术后24h花生四烯酸途径(AA)抑制率、二磷酸腺苷(ADP)抑制率、二磷酸腺苷诱导最大血块强度(MA-ADP)水平,全因死亡率,MACE发生率及出血事件发生率.结果:观察组患者残余血小板高反应性发生率显著低于对照组(P＜0.05);观察组患者术后24h血栓弹力图指标水平均显著优于对照组(P＜0.05);两组患者全因死亡率、脑卒中、再发心肌梗死及心源性猝死发生率比较,差异无统计学意义;观察组患者支架内血栓发生率显著低于对照组(P＜0.05);两组患者出血事件发生率比较,差异无统计学意义.结论:相较于氯吡格雷,阿司匹林联合替格瑞洛用于ACS合并T2DM患者可显著降低残余血小板高反应性,提高抗血小板效果,并有助于预防支架内血栓发生.%Objective:To investigate the influence of aspirin separately combined with clopidogrel and ticagrelor on platelet reactivity,MACE and bleeding events after PCI of patients with ACS complicated with T2DM.Methods:120 patients with ACS complicated with T2DM were chosen and randomly divided into 2 groups including control group (63 patients) with clopidogrel and observation group (57 patients) with ticagrelor on the basis of aspirin;and the high platelet reactivity incidence,inhibitory rate of AA and ADP and MA-ADP in 24h after operation,all-cause mortality,the incidence of MACE and bleeding events of both groups were compared.Results:The high platelet reactivity incidence of observation group were significant lower than control group(P ＜ 0.05).The TEG index in 24h after operation of observation group were significant higher than control group(P ＜0.05).The incidence of subacute thrombosis of observation group were significant lower than control group(P ＜ 0.05).There was no significant difference in the all-cause mortality and the incidence of stroke,recurrent myocardial infarction and sudden cardiac death between 2 groups.There was no significant difference in the incidence of bleeding events between 2 groups.Conclusion:Compared with clopidogrel,ticagrelor combined with aspirin in the treatment of patients with ACS complicated with T2DM can efficiently reduce the high platelet reactivity,improve the anti-platelet effects and prevent the substent thrombosis.
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