冠状动脉介入治疗术后三联抗血小板治疗对冠心病合并糖尿病患者的影响

Impact of triple anti-platelet therapy on activation of platelet and short-term outcomes in CHD patients with diabetes undergoing PCI

目的探讨冠心病合并糖尿病患者冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后阿司匹林、氯吡格雷及西洛他唑三联抗血小板治疗对血小板功能及短期预后的影响。方法 318例患者分为双联抗血小板组和三联抗血小板组,于术前、术后7天及术后30天测定P-选择素及血小板聚集率(platelet aggregation rate,PAR),并且统计1个月内主要心血管不良事件(major adverse cardiovascular events,MACE)发生率。结果术后7天、术后30天三联组较双联组P-选择素表达率均显著降低,差异均有统计学意义[(5.25±2.09)%vs(6.03±2.12)%,(2.67±1.67)%vs(3.24±1.98)%,P<0.05]。术后7天、术后30天三联组较双联组PAR均显著降低,差异均有统计学意义[(22.02±6.02)%vs(29.06±5.71)%,(20.03±4.62)%vs(26.78±4.35)%,P<0.05]。随访1个月,三联组及双联组MACE发生率分别为1.85%(3/162)、7.05%(11/156),差异有统计学意义(P<0.05)。出血的发生率分别为9.26%(15/162)、7.05%(11/156),差异无统计学意义(P>0.05)。结论三联抗血小板治疗能够更有效地抑制冠心病合并糖尿病患者血小板的活化和聚集,降低PCI术后MACE事件发生率且不增加出血风险。

Objective To discuss the curative effect and safety of triple antiplatelet therapy in coronary heart disease（CHD） patients with diabetes mellitus after percutaneous coronary intervention （PCI） for further clinical application of cilostazol. Methods A total of 318 patients were randomly divided into triple antiplatelet therapy group and dual antiplatelet therapy group. Blood sample was collected before PCI, 7 and 30 days after PCI for determination of P-selectin and platelet aggregation rate（PAR）, and then, major adverse cardiac events（MACE） and hemorrhage events were measured. Results Seven and 30 days after PCI, the expression rate of P-seleetin was lower in the triple treatment group than that of the dual treatment group, （5.25±2.09）G vs （6.03±2.12）% ,（2.67±1.67）G vs （3.24 ±1.98）% （ P 〈0.05）. The expression rate of PAR was also lower, （22.02±6.02）% vs （29.06±5.71）%, （20.03±4.62）% vs （26.78±4.35）%（ P 〈0.05）. MACE was decreased in the triple treatment group as compared with that in the dual treatment group （1.85% vs 7.05%, P 〈0.05）. Conclusion Compared with dual antiplatelet therapy after PCI in CHD patient with diabetes mellitus, triple antiplatelet therapy inhibits platelet activation and aggregation more effectively, reduces the incidence of 1-month MACE events,but does not increase the risk of bleeding.