糖尿病患者冠状动脉旁路移植术后阿司匹林抵抗的临床研究

Clinical research of aspirin resistance on patients with diabetes mellitus after off-pump coronary artery bypass grafting

目的探讨冠心病合并糖尿病患者非体外循环下冠状动脉旁路移植(OPCAB)术后阿司匹林抵抗(AR)的发生情况。方法将36例行OPCAB的患者分为糖尿病(DM)组与非糖尿病(NDM)组,每组18例。术后应用阿司匹林(100 mg/d)治疗,分别于术前阿司匹林停药前(T_0),术后服用阿司匹林后6 h(T_1)、第5天(T_2)及第14天(T_3)采集静脉血,应用血栓弹力图(T_EG)检测血小板聚集抑制率(INHAA)及AR发生率。结果 DM组INHAA在T_1、T_2时点均比T_0显著减低(P<0.01或P<0.05),NDM组INHAA在T_1比T_0显著减低(P<0.01),两组在T_3时点比T_0差异均无统计学意义(P>0.05);两组AR发生率在T_1、T_2及T_3时点均比T_0显著增高(P<0.01)。组间比较:在T_1、T_2时点DM组INHAA均显著低于NDM组(P<0.01或P<0.05),AR发生率均显著高于NDM组(P<0.05);在T_3时点比较差异无统计学意义(P>0.05)。结论 OPCAB术后早期DM患者更易出现抗血小板药物抵抗。

Objective T_o investigate aspirin resistance（ AR） after off-pump coronary artery bypass grafting（ OPCAB） in diabetes mellitus（ DM） patients combined with coronary heart disease. Methods T_hirty-six cases undergoing OPCAB were divided into DM group and non-diabetes mellitus（ NDM） group,there were 18 cases in each group. Aspirin was utilized with dosage of 100 mg / d as postoperative antiplatelet therapy. AA-induced inhibition rate（ INHAA） of platelet and incidences of AR were measured and calculated by thrombelastography（ T_EG） at different time points： T_0（ the day before aspirin was withdrew）,T_1（ 6 hours after first application of aspirin after OPCAB）,T_2（ the 5th day of aspirin therapy）,T_3（ the 14 th day of aspirin therapy）. Results INHAA was reduced significantly at T_1 and T_2than those at T_0 in DM group（ P〈0. 01 or P〈0. 05） and reduced significantly at T_1 than that at T_0 in NDM group（ P〈0. 01）,and variance was not significant at T_3 than that at T_0 in two groups（ P〈0. 05）; incidence of AR was increased significantly at T_1,T_2 and T_3than those at T_0 in two groups（ P〈0. 01）. At T_1 and T_2,INHAA in DM group was lower than that in NDM group（ P〈0. 01 or P〈0. 05） and incidence of AR was higher than that in NDM group（ P〈0. 05）,and at T_3 there was no statistical significance（ P〈0. 05）.Conclusion Patients with DM occur resistance of antiplatelet drug easily in early postoperative time of OPCAB.