冠心病合并糖尿病患者血小板功能变化及抗血小板治疗进展

The Variation of Platelet Function in Patients with Coronary Heart Disease and Diabetes Mellitus and the Advance of Anti-platelet Therapy

目前临床上冠心病合并糖尿病呈高发态势,与单纯冠心病相比,合并糖尿病的患者其血小板平均体积、血小板压积、血小板分布宽度、大血小板比率升高,血小板黏附性、活性、聚集性进一步增强,3支病变或(和)左主干病变发生率明显增高,且重度狭窄病变,闭塞病变率明显增高。通过对两者的发病机制分析发现,冠心病和糖尿病互为等危症,其共同的发病机制为炎症反应,而血小板在炎症反应中发挥重要作用,不但参与动脉粥样硬化的形成,还参与斑块的破裂,血管内血栓的形成,针对冠心病合并糖尿病患者进行个体化安全的抗血小板治疗尤为重要。本文概述了冠心病合并糖尿病患者血小板参数及功能变化,分析了冠心病合并糖尿病患者血小板功能改变的有关机制,综述了目前临床上抗血小板药物的作用机制及治疗疗效,以期对临床治疗起到指导作用。

Currently,the clinical incidence rate of coronary heart disease（CHD）and diabetes mellitus（DM）is high. Compared with CHD patients,the mean platelet volume（MPV）,plateletcrit（PCT）,platelet distribution width（PDW）and platelet-large cell rate（P-LCR）are obviously higher,and the platelet adhesion,activation and aggregation are further enhanced in CHD patients complicated with DM. The incidence rates of three-vessel lesions or（and）left main coronary artery lesions,severe stenosis and occlusion are increased significantly in patients with CHD and DM. The common pathogenesis of CHD and DM is inflammatory reaction. Platelets play an important role in inflammatory reaction,not only participate in the the formation of atherosclerosis,but also involve in the rupture of plaque and the formation of intravascular thrombus. So the individualized and safe anti-platelet therapy is particularly important for patients with CHD and DM. This review summarizes the changes of platelet parameters and function in patients with CHD complicated with DM and the related mechanisms,and also summarizes the mechanisms and clinical curative effect of anti-platelet drugs,in order to guide the clinical treatment.