阿司匹林和西洛他唑对冠心病合并糖尿病患者血小板聚集活性的影响

Effect of aspirin and cilostazol on aggregation of platelet in coronary artery disease patients with or without diabetes

目的：探讨阿司匹林对冠心病合并糖尿病患者血小板聚集活性的影响;西洛他唑对血小板聚集活性作用是否有类似改变。方法：入选的冠心病患者中合并与合并2型糖尿病患者各45例。根据其口服药物又分为阿司匹林组、西洛他唑组和联合用药组,每组各15例。记录患者基本情况并测定血小板聚集活性、血浆血栓素（TX）B2、6-K-前列腺素（PG）F1a和髓过氧化物酶（MPO）水平,并进行统计分析。结果：（1）多元逐步回归分析显示血糖是影响血小板聚集的独立因素（R=0.914,P〈0.01）;（2）方差分析显示糖尿病患者血小板聚集活性、血浆TXB2、MPO水平较非糖尿病患者明显增高,6-K-PGF1a水平降低（P〈0.001）;（3）非糖尿病患者阿司匹林组和西洛他唑组血小板聚集活性和TXB2没有明显差异,西洛他唑组血浆6-K-PGF1a水平高于阿司匹林组,而MPO水平低于阿司匹林组（P〈0.001）;糖尿病患者西洛他唑组血小板聚集活性、TXB2和MPO水平低于阿司匹林组,而6-K-PGF1a水平高于阿司匹林组（P〈0.05-0.001）。结论：对冠心病合并糖尿病患者西洛他唑较阿司匹林可以更有效地抑制血小板聚集。

Objective： To evaluate the effect of aspirin and cilostazol on aggregation of platelet in coronary heart disease （CHD） patients with or without diabetes. Methods： The 45 CHD patients with type 2 diabetes mellitus （DM） and 45 CHD patients without DM were selected according to inclusive criteria. Two groups were divided into aspirin groups, cilostaxol groups and combinative groups according to administer drugs respectively. The aggregation of activated platelet, TXB2, 6-K-PGF1a and MPO were detected and analyzed for their correlation. Those data were compared among groups. Results： （1） Multivariate correlative analysis showed that blood glucose was the most important factor correlated with the aggregation of activated platelet （R=0. 914, P〈0. 01）; （2） Compared the without diabetes group, the level of aggregation of activated platelet, TXB2, MPO increased, the level of 6-K-PGF1a decreased in CHD patients with diabetes group; （3） For patients without DM, the level of aggregation of activated platelet and TXB2 had no significant difference between aspirin and cilostazol groups, the level of 6-K-PGF1a was higher, while the level of MPO was lower in cilostazol group than those of aspirin group （P〈0. 001）. For patients with DM, the level of the aggregation of activated platelet, TXB2, MPO were lower while the level of 6-K-PGF1a was higher in cilostazol group than those of aspirin group （P〈0.05-〈0. 001）. Conclusion： Cilostazol is more effective than aspirin to inhibit the aggregation of activated platelet for CHD patients with DM.