氯吡格雷抵抗与胰岛素抵抗的相关分析

Correlation analysis on clopidogrel resistance and insulin resistance

目的观察不稳定型心绞痛患者中胰岛素抵抗与氯吡格雷抵抗之间的关系。方法90例冠心病不稳定型心绞痛患者常规服用阿司匹林100mg/d,确诊后给予氯吡格雷维持量75mg/d。所有患者均于服药前采集静脉血,以测定Ⅱb/Ⅲa受体复合物的阳性表达率,并于服药后第4天再次抽血测定血小板的Ⅱb/Ⅲa的阳性表达率,氯吡格雷抵抗定义为用药后GPⅡb/Ⅲa值升高>1.40。同时分别测定血小板计数、血浆纤维蛋白原、基础血小板的聚集率、空腹血糖(FBG)、空腹胰岛素(FINS),并计算胰岛素敏感指数(ISI)。结果90例患者中产生氯吡格雷抵抗19例(氯吡格雷抵抗组)。氯吡格雷抵抗组与非氯吡格雷抵抗组的基础血小板的聚集率、血小板计数、血浆纤维蛋白原、空腹血糖(FBG)、空腹胰岛素(FINS)和胰岛素敏感指数(ISI)比较基础血小板聚集率差异有统计学意义(P<0.05),其他比较差异不明显(P>0.05)。结论不稳定型心绞痛患者的氯吡格雷抵抗发生率约为21.1%,血浆纤维蛋白原水平并非氯吡格雷抵抗的影响因素,胰岛素抵抗与氯吡格雷抵抗发生率无相关性。

Objective To investigate the relation of insulin resistance and elopidogrel resistance in patients with unstable angina . Methods After 90 patients undergoing unstable angina were diagnosed, clopidogrel were given on maintenance dose 75mg/d. Blood samples were obtained through venipuncture before clopidogrel administration to measure the baseline levels of the expression of membrane glycoprotein GP Ⅱb/Ⅲa on the platelets. Four days after clopidogrel administration, venous blood specimens were obtained to measure the expression of GP Ⅱb/Ⅲa on the platelets again. According to the changes of GP Ⅱb/Ⅲa expression prior to and 4 days after elopidogrel administration, patients were divided into clopidogrel resistance group and non-clopidogrel resistance group. Meanwhile we examined the basic platelet aggregation rate, the plasma fibrinogen, the platelet count. Fasting plasma glucose （FPG） and fasting serum insulin （ FINS ） were tested, the insulin sensitivity index （ISI） were calculated. Results The platelet count, the plasma fibrinogen,the FPG, the FINS and the ISI in clopidogrel resistance group were not obviously different from those in non-clopidogrel aggregation group （ P 〈 0.05 ）. There was significant difference in the basic platelet aggregation rate between two groups （ P 〈 0.05 ）. Conclusion The incidence of insulin resistance in unstable angina patients was 21.1%. The level of plasma fibrinogen was not the influencing factors in elopidogrel resistance. There were not significant correlation between insulin resistance and clopidogrel resistance.