血小板高反应性对冠心病并发2型糖尿病患者PCI手术效果的影响

Influence of platelet hyperresponsiveness on PCI operative effect in patients with coronary heart disease complicating type 2 diabetes mellitus

目的研究血小板高反应性(HPR)对冠心病并发2型糖尿病患者经皮冠状动脉介入治疗(PCI)手术效果的影响。方法回顾性分析2013年6月至2016年6月于该院接受检查治疗的冠心病患者165例,选取61例冠心病并发2型糖尿病患者作为糖尿病组,104例单纯冠心病患者作为非糖尿病组,在引导患者服用双联抗血小板药物后进行PCI治疗,分别使用血栓弹力图检测患者的血小板聚集情况。医护人员在术后随访6个月仔细记录出现的不良心血管症状,最后对所有数据信息进行分析对比。结果 2组患者的手术资料比较,其中糖尿病组患者的单支病变为19例(31.15%)、3支病变为26例(42.62%),非糖尿病组的单支病变为48例(46.15%)、3支病变为23例(22.12%),2组比较差异有统计学意义(P<0.05)。血栓弹力图测量糖尿病组二磷酸腺苷(ADP)作用下的血小板聚集率为38.6%(33.1%,43.8%)、ADP作用下的HPR率为18例(29.51%),非糖尿病组ADP作用下的血小板聚集率为27.9%(21.8%,36.7%),ADP作用下的HPR为16例(15.38%),2组比较差异有统计学意义(P<0.05)。PCI后随访期间统计患者的心源性死亡、卒中、支架内血栓与严重胸痛发生状况,通过分析糖尿病组心血管事件(MACE)发生率为10例(16.39%),非糖尿病组MACE发生率为7例(6.73%),差异有统计学意义(P<0.05)。结论冠心病合并2型糖尿病患者在PCI手术后易发生HPR,且会增加MACE的发生率。

ObjectiveTo investigate the influence of platelet hyperresponsiveness（HPR）on PCI operative effect in the patients with coronary heart disease（CHD）complicating type 2 diabetes mellitus（T2DM）.MethodsA total of 165 patients with CHD receiving the examination and treatment in this hospital from June 2013 to June 2016 were retrospectively analyzed.Among them,61 cases of CHD complicating T2DM were selected as the diabetes group,and 104 cases of simple CHD served as the non diabetes group.The PCI treatment was performed after guiding the patients to take double antiplatelet drugs.The platelet aggregation situation was detected by using the thrombelastogram.The adverse cardiovascular symptoms were recorded during postoperative 6 month follow up by medical staff,finally all the data information were performed the analysis and comparison.ResultsIn the operative data comparison between the two group,there were 19 cases（31.15%）of single vessel lesion and 26 cases（42.62%）of 3 vessels lesion in the diabetes group,while there were 48 cases（46.15%）of single vessel lesion and 23 cases（22.12%）of 3 vessel lesion in the non diabetic group,the differences between the two groups were statistically significant（P〈0.05）.The platelet aggregation rate under ATP action detected by thrombelastogram in the diabetes group was 38.6%（33.1%,43.8%）and HPR rate under ATP action had 16 cases（29.51%）,which in the non diabetes group was 27.9%（21.8%,36.7%）and had 16 cases,the differences between the two groups were statistically significant（P〈0.05）.The occurrence situation of cardiac death,stroke,stent thrombus and severe chest pain during the follow up period after PCI were performed statistical analysis,the results showed that the main adverse cardiovascular event（MACE）occurrence rate was 10 cases（16.39%）in the diabetes group and 7 cases（6.73%）in the non diabetic group,the difference was statistically significant（P〈0.05）.ConclusionCHD complicating T2DM is prone to platelet hyperresponsiveness after PCI,and can increase the incidence of MACE.