合并2型糖尿病的急性冠脉综合征患者PCI术后氯吡格雷抵抗危险因素分析

摘要

Objective To discuss the clopidogrel resistance in patients with type 2 diabetes mellitus complicated with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). Methods The patients with ACS (n=84) re-ceived PCI were randomly divided into diabetic group and non-diabetic group (42 cases in each group). The platelet aggrega-tion rate was compared by using Thrombelastography(TEG) between 2 groups after treatment with clopidogrel. The basic clini-cal data,related routine examination results were also compared between 2 groups. Independent risk factors of clopidogrel resis-tance were explored by multiple factor analysis. Results 11 patients (26.19%) had clopidogrel resistance in diabetic group, and 1 patient (2.38%) had clopidogrel resistance in non-diabetic group, the difference was statistically significant (P<0.05). While the fasting blood glucose,HbA1c lever,triglyceride and high sensitive C reactive protein in diabetic group were significant higher than those in non-diabetic group (P<0.05). The fasting blood glucose,HbA1c lever and high sensitive C reactive protein were risk factors of clopidogrel resistance in patients. Conclusion Type 2 diabetic patients with ACS undergoing PCI have a higher clopidogrel resistance rate than those non-diabetic patients, and that relevant factors are the fasting blood glucose,HbA1c lever and high sensitive C reactive protein.%目的：探讨合并2型糖尿病（DM）的急性冠脉综合征（ACS）患者经皮冠状动脉介入术（PCI）后发生氯吡格雷抵抗的情况，分析相关危险因素。方法84例因ACS入院行PCI的患者，分为糖尿病组42例，非糖尿病组42例，根据血栓弹力图（TEG）监测血小板抑制率情况，比较两组临床资料，分析糖尿病患者氯吡格雷抵抗的相关危险因素。结果糖尿病组发生氯吡格雷抵抗11例（26.19%），非糖尿病组发生1例（2.38%），差异有统计学意义（P＜0.05）；糖尿病组空腹血糖水平、糖化血红蛋白（HbA1c）水平、甘油三酯、超敏C反应蛋白水平（hs-CRP）均明显高于非糖尿病组（P＜0.05）；分析显示空腹血糖、糖化血红蛋白、超敏C反应蛋白是影响患者发生氯吡格雷抵抗的危险因素。结论合并2型糖尿病的ACS患者氯吡格雷抵抗发生率高，且与患者的空腹血糖水平、糖化血红蛋白水平、超敏C反应蛋白水平密切相关。