冠心病合并糖尿病患者行经皮冠状动脉介入治疗后CD62p与氯吡格雷抵抗的相关性研究

Correlation between CD62p and clopidogrel resistance in patients undergoing percutaneous coronary intervention with coronary heart disease combined with diabetes mellitus

目的探讨冠心病合并糖尿病患者行经皮冠状动脉介入治疗后CD62p与氯吡格雷抵抗的相关性研究。方法选择2013年8月—2016年12月在北京市昌平区医院行经皮冠状动脉介入治疗的冠心病合并糖尿病患者150例,所有患者手术前后接受氯吡格雷治疗,比较患者治疗前后血小板聚集率的变化情况,根据血小板聚集率变化的幅度是否≥10%,将患者分为氯吡格雷有效(C2)组和氯吡格雷抵抗(C1)组,分别检测两组患者CD62p以及血小板最大聚集率(PAGM)的水平,并分析其变化与血小板聚集率变化情况的相关性。结果经治疗,患者血小板聚集率较治疗前均显著降低,差异有统计学意义(P<0.05)。根据血小板聚集率下降幅度分为C1组(57例)和C2组(93例),其中C1组患者CD62p较治疗前显著降低,差异有统计学意义(P<0.05);C2组患者CD62p、PAGM较治疗前均显著降低,且变化幅度显著大于C1组,差异有统计学意义(P<0.05);C2组治疗前后CD62p的变化幅度与PAGM下降幅度的相关性(r=0.424,P=0.001)优于C1组(r=0.387,P=0.020)。结论氯吡格雷对冠心病合并糖尿病患者行经皮冠状动脉介入治疗后血小板的活性具有一定的抑制作用,氯吡格雷抵抗可能与血小板活性状态相关。

Objective To explore the correlation between CD62 p and clopidogrel resistance in patients undergoing percutaneous coronary intervention with coronary heart disease combined with diabetes mellitus. Methods 150 patients ndergoing percutaneous coronary intervention with coronary heart disease combined with diabetes mellitus were enrolled in our hospital from August 2013 to December 2016, of all patients accepted clopidogrel treatment, the platelet aggregation rate were analyzed before and after treatment, which all patients divided into two groups as the range of decreasing platelet aggregation rate whether ≥10%, clopidogrel effective group（C2） and clopidogrel resistance group（C1） were detected CD62 p and platelet aggregation maximum（PAGM）, the relevance of which range with platelet aggregation rate was analyzed. Results After treatment, the platelet aggregation rate of all patient decreased significantly（P〈0.05）. Of all patients divided into clopidogrel effective group（C2） and clopidogrel resistance group（C1） as the range of decreasing platelet aggregation rate, and the CD62 p of Group C1 decreased compared with before treatment（P〈0.05）, the level of CD62 p and PAGM in Group C2 were decreasing compared with pre-treatment, and the range of which was larger than those Group C1（P〈0.05）. The reference of CD62 p and PAGM in Group C2（r = 0.424, P = 0.001） was better than that Group C1（r = 0.387, P = 0.020）. Conclusions Clopidogrel for patients undergoing percutaneous coronary intervention with coronary heart disease combined with diabetes mellitus possessed inhibition for platelet activity, and clopidogrel resistance might be associated with platelet activity.