老年2型糖尿病患者中阿司匹林抵抗的远期预后观察

Long-term prognosis of aspirin resistance in elderly patients with typeⅡdiabetes mellitus

目的研究老年糖尿病患者合并阿司匹林抵抗的远期预后。方法选取2008年4月-2010年4月220例糖尿病服用阿司匹林（75-100 mg/d,≥1月）的老年患者,采用花生四烯酸诱导的光比浊法诊断阿司匹林抵抗,于2014年12月份对患者进行随访,平均随访日期（53.45±20.16）月。终点事件为随访期间首次发生急性缺血性动脉血栓性（心肌梗死、心源性猝死、缺血性卒中、不稳定型心绞痛、短暂性脑缺血发作）及全因性死亡事件。结果糖尿病患者阿司匹林抵抗发生率为14.5%（32/220）,阿司匹林抵抗组不良事件发生率为50.0%（16/32）,阿司匹林不抵抗组不良事件发生率为25.5%（48/188）,差异有统计学意义（50.0%vs.25.5%,P=0.005）。Kaplan-Meier生存曲线显示糖尿病患者阿司匹林抵抗发生不良事件的风险是非阿司匹林抵抗患者的2.19倍（CI=1.07-4.54;P〈0.01）,经多因素Cox回归法校正,阿司匹林抵抗发生不良事件的风险仍然是非阿司匹林抵抗患者的2.14倍（CI=1.16-3.96;P=0.02）。结论光比浊法诊断的阿司匹林抵抗可以作为糖尿病患者预后不良的一个分子标识和预告因子。

Objective To study the Long-term prognosis of elderly aspirin resistance（AR） patients with type Ⅱ diabetes mellitus（T2DM）. Methods From April 2008 to April 2010,220 elderly patients with T2 DM and treated with aspirin monotherapy（75 - 100 mg,≥ 1 month） were consecutively enrolled. AR was defined with light transmission aggregometry（LTA）. Patients were followed up with in December 2014 and adverse clinical events（myocardial infarction,stroke,unstable angina,transient ischemic attack and death） during a 53.45 ± 20.16 11.60-month follow-up period were assessed. Results In elderly population,the incidence of AR in diabetic patients was 14.5%（32/220）. The incidence of adverse events in patients with and without AR were50.0%（16/32） and 25.5%（48/188） respectively; the difference was statistically significant（P = 0.005）. AR patients with T2 DM had higher risk of experiencing adverse clinical events than non-AR patients with T2 DM according to Kaplan-Meier analysis（HR =2.19; CI：1.07 - 4.54;P〈0.01）. By multivariate Cox regression,AR patients showed an 1.14-fold increase in risk of adverse events than non-AR patients in DM（CI：1.16 - 3.96;P = 0.02）. Conclusion AR defined by LTA can be used as a marker and predictor for poor prognosis of diabetic patients.