老年冠心病合并糖尿病患者氯吡格雷抵抗的危险因素分析

Risk factors of clopidogrel resistance in elderly patients with coronary heart disease complicating diabetes

目的 分析老年冠心病合并糖尿病患者氯吡格雷抵抗的危险因素。方法 选取咸阳市中心医院心内科自2008年6月~2014年1月收治入院的接受氯吡格雷治疗的合并糖尿病的老年冠心病患者89例,男性48例,女性41例。根据血栓弹力图检测,抑制率〉50%者为对照组（n=44）,抑制率〈50%者为观察组（n=45）,比较两组空腹血糖（FPG）、糖化血红蛋白（Hb A1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、心肌肌钙蛋白I（c TNI）,超敏C反应蛋白（hs-CRP）,分析氯吡格雷抵抗的危险因素。结果 观察组在吸烟比例、LDL-C、FPG、Hb A1c、hs-CRP,c Tn I等方面均高于对照组,差异具有统计学意义（P均〈0.05）。结果显示患者FPG（OR=1.879,95%CI：0.954~2.145）、Hb A1c（OR=1.512,95%CI：0.843~1.991）、hsCRP（OR=2.143,95%CI：0.576~2.662）、c Tn I（OR=1.314,95%CI：0.104~3.106）是氯吡格雷抵抗的独立危险因素。观察组术后出现5例心肌梗死,对照组出现1例心肌梗死,两组心肌梗死发生率差异具有统计学意义（P〈0.05）。结论 FPG、Hb A1c、hs-CRP、c Tn I增高是老年冠心病合并糖尿病患者介入治疗术后氯吡格雷抵抗的独立危险因素。

Objective To analyze the risk factors of clopidogrel resistance in elderly patients with coronary heart disease （CHD） complicating diabetes. Methods The patients （n=89, male 48 and female 41） were chosen from Jun. 2008 to Jan. 2014. According to examination of thrombelastogram （TEG）, all patients were divided into control group （inhibition rate〉50%, n=44） and observation group （inhibition rate〈50%, n=45）. The levels of fasting plasma glucose （FPG）, glycated hemoglobin （HbAlc）, total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein-cholesterol （HDL-C）, low-density lipoprotein-cholesterol （LDL-C） and cardiac troponin I （cTnI） were compared between 2 groups, and risk factors of clopidogrel resistance were analyzed. Results The percentage of smoking cases, and levels of LDL-C, FPG, HbA1c, hs-CRP and cTnI were higher in observation group than those in control group （all P〈0.05）. FPG （OR=1.879, 95%CI：0.954~2.145）, HbA1c （OR=1.512, 95%CI：0.843~1.991）, hs-CRP （OR=2.143, 95%CI： 0.576~2.662） and cTnI （OR=1.314, 95%CI： 0.104~3.106） were independent risk factors of clopidogrel resistance. There were 5 cases of myocardial infarction in observation group and 1 in control group （P〈0.05） after interventional therapy. Conclusion The higher levels of FPG, HbA1c, hs-CRP and cTnI are independent risk factors of clopidogrel resistance in elderly patients with CHD complicating diabetes after interventional therapy.