冠心病合并糖尿病患者经皮冠状动脉介入治疗后氯吡格雷低反应的发生率及危险因素

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摘要 [摘要] 目的评价择期经皮冠状动脉介入治疗的冠心病合并2型糖尿病患者中氯吡格雷低反应的发生率及危险因素。方法采用回顾性病例对照研究，选取2015年1~9月于首都医科大学附属北京安贞医院行经皮冠状动脉介入治疗的冠心病合并2型糖尿病患者210例，所有患者均于术前至少6 h给予负荷量的氯吡格雷300 mg，分别于服药前及服药至少24 h后取血，光学比浊法测定二磷酸腺苷（ADP）诱导的血小板聚集率。服药前血小板聚集率与服药后血小板聚集率绝对差值≤10％定义为氯吡格雷低反应，据此将患者分为正常组（n=133）和低反应组（n=77），计算氯吡格雷低反应的发生率，并分析年龄、性别、吸烟、血压、血脂、糖化血红蛋白等指标与氯吡格雷低反应的相关性。结果经皮冠状动脉介入术后的冠心病合并2型糖尿病患者中氯吡格雷低反应的发生率为36.67%。低反应组和正常组ADP诱导的血小板聚集率在基线水平差异无统计学意义（P > 0.05），在服药24 h后测定分别为（62.62±9.23）%与（32.71±11.77）%，两组间差异有高度统计学意义（P < 0.01）。多因素Logistic回归分析结果显示，高糖化血红蛋白水平是氯吡格雷低反应的独立危险因素（P =0.037，OR=1.241，95%CI 1.013~1.519）。结论高糖化血红蛋白水平是冠心病合并糖尿病患者中氯吡格雷低反应的独立危险因素。冠心病合并糖尿病患者中氯吡格雷低反应显著发生，控制糖化血红蛋白在临床上至关重要。

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	翟光耀周玉杰▲

关键词 ： [关键词] 经皮冠状动脉介入, 氯吡格雷低反应, 糖化血红蛋白, 糖尿病

Abstract：[Abstract] Objective To assess the incidence of low response of Clopidogrel and its risk factors in patients with coronary heart disease and type 2 diabetes treated with percutaneous coronary intervention (PCI). Methods A retrospective case-control study was adopted in this study. 210 patients with coronary heart disease and type 2 diabetes who underwent selective PCI in Beijing Anzhen Hospital Affiliated to Capital Medical University from January to September 2015 were selected. All patients received a loading dose of Clopidogrel 300 mg at least 6 h before PCI. All the patients were taken blood samples before Clopidogrel administration as the baseline and at least 24 h post-medication. ADP induced platelet aggregation was measured by light transmittance aggregometry. Low response of Clopidogrel was defined as the absolute difference of the platelet between baseline and post-medication ≤10%. The patients were divided into the normal group (n=133) and the low-response group (n=77), the incidence of low response of Clopidogrel was calculated, and the correlation between age, gender, smoking, blood pressure, blood lipid, HbA1c and low response of Clopidogrel was analyzed. Results The incidence of low response of Clopidogrel in patients with coronary heart disease and type 2 diabetes after selective PCI was 36.67%. There was no significance in the ADP induced platelet aggregation rates between the normal group and the low-response group at baseline (P > 0.05); the platelet aggregation rates of the two groups on 24 h post-medication were (62.62±9.23)% and (32.71±11.77)% respectively, there was significant difference between two groups (P < 0.01). Multivariate Logistic regression analysis found that high level of HbA1c was an independent risk factor of low response of Clopidogrel (P=0.037, OR=1.241, 95%CI 1.013-1.519). Conclusion High level of HbA1c is an independent risk factor of low response of Clopidogrel in patients with coronary heart disease and type 2 diabetes. Low response of Clopidogrel exists significantly in patients with coronary heart disease and type 2 diabetes, making controlled levels of HbA1c is clinically crucial.

Key words： [Key words] Percutaneous coronary intervention Low response of Clopidogrel HbA1c Diabetes

基金资助:[基金项目] 国家自然科学基金项目（81270285）；国家临床重点专科建设项目（国卫医发[2013]42号）；北京市医院管理局重点医学专业发展计划项目（ZYLX201303）。

作者简介: [作者简介] 翟光耀（1988.4-），男，博士；研究方向：心血管内科专业及介入治疗。

引用本文:

翟光耀周玉杰▲. 冠心病合并糖尿病患者经皮冠状动脉介入治疗后氯吡格雷低反应的发生率及危险因素[J]. 中国医药导报, 2016, 13(3): 13-16.
ZHAI Guangyao ZHOU Yujie▲. Incidence of low response of Clopidogrel and its risk factors in patients with coronary heart disease and type 2 diabetes treated with percutaneous coronary intervention. 中国医药导报, 2016, 13(3): 13-16.

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[1] Coccheri S. Antiplatelet therapy：controversial aspects [J]. Thromb Res，2012，129（3）：225-229.
[2] 柳亚敏，邵华，厉伟兰，等.急性冠状动脉综合征患者对氯吡格雷反应的变异性与再发心血管事件的关系[J].药物不良反应杂志，2014，16（1）：10-14.
[3] Gurbel PA，Bliden KP，Hiatt BL，et al. Clopidogrel for coronary stenting：response variability，drug resistance，and the effect of pretreatment platelet reactivity [J]. Circulation，2003，107（23）：2908-2913.
[4] Serebruany VL，Steinhubl SR，Berger PB，et al. Variability in platelet responsiveness to clopidogrel among 544 individuals [J]. J Am Coll Cardiol，2005，14（5）：246-251.
[5] Hochholzer W，Trenk D，Frundi D，et al. Time dependence of plateletinhibition after a 600-mg loading dose of clopidogrel in a large，unselected cohort of candidates for percutaneous coronary intervention [J]. Circulation，2005，111（20）：2560-2564.
[6] Geisler T，Langer H，Wydymus M，et al. Low response to clopidogrelisassociated with cardiovascular outcome after coronary stent implantation [J]. Eur Heart J，2006，27（20）：2420-2425.
[7] Buonamici P，Marcucci R，Migliorini A，et al. Impact of platelet reactivity afterclopidogrel administration on drug-eluting stent thrombosis [J]. J Am Coll Cardiol，2007， 49（24）：2312-2317.
[8] Price MJ，Endemann S，Gollapudi RR，et al. Prognostic significance ofpost·clopidogrel platelet reactivity assessed by a point-of-care assay onthrombotic events after drug-eluting stent implantation [J]. Eur Heart J，2008，29（8）：992-1000.
[9] 富志南，魏广成，马合金，等.个体化健康教育与促进对糖尿病患者血糖及并发症的影响[J].河北医学，2015，21（12）：2083-2086.
[10] 侯艳杰.心率变异性在冠心病患者和冠心病合并糖尿病患者中应用价值的比较[J].临床和实验医学杂志，2015， 14（4）：294-296.
[11] 何鸿雁.氯吡格雷联合阿司匹林对急性冠脉综合征PCI术后患者血小板聚集功能及预后的影响[J].北方药学，2015，12（1）：75-76.
[12] 王晓，朱均权.凝血因子V、Ⅷ和组织因子与2型糖尿病合并冠心病的关系[J].检验医学，2014，29（1）：34-37.
[13] 陈彪.氯吡格雷治疗不稳定型心绞痛的临床疗效观察[J].中国卫生标准管理，2015，6（20）：99-100.
[14] 魏雪梅，朱庆华，谷世奎，等.替格瑞洛在氯吡格雷抵抗急性心肌梗死患者PCI术后抗血小板治疗中的应用效果[J].山东医药，2015，55（15）：46-48.
[15] Edwards J，Goodman SG，Yan RT，et al. Has the clopidogrel and metoprolol in myocardial infarction trial（commit）of early beta-blocker use in acute coronary syndrome impacted on clinical practice in Canada [J]. Am Heart J，2011，161（2）：291-297.
[16] 李英松.阿司匹林肠溶片联合氯吡格雷治疗冠心病心绞痛临床效果评价[J].中国继续医学教育，2015，7（11）：214-215.
[17] 沈卫峰.“2013年ACCF/AHAST段抬高型心肌梗死处理指南”点评[J].国际心血管病杂志，2013，40（1）：1-2.
[18] Colwell JA，Nesto RW. The platelet in diabetes：focus on prevention of ischemic events [J]. Diabetes Care，2012，26（7）：2181-2188.
[19] Siller-Matula JM，Huber K，Christ G，et al. Impact of clopidogrel loading dose on clinical outcome in patients undergoing percutaneous coronary intervention：a systematic review and meta-analysis [J]. Heart，2011，97（2）：98.
[20] Campo G，Parrinello G，Ferraresi P，et al. Prospective evaluation of on-clopidogrel platelet reactivity over time in patients treated with percutaneous coronary intervention：relationship with gene polymorphisms and clinical outcome [J]. JACC，2011，57（25）：2474-2483.