二甲双胍对冠状动脉粥样硬化性心脏病合并2型糖尿病患者经皮冠状动脉介入术后抗血小板药物敏感性的影响

Metformin improves antiplatelet drug sensitivity in patients with coronary heart disease complicated with type 2 diabetes mellitus after PCI

目的探讨二甲双胍对冠状动脉粥样硬化性心脏病(CHD)合并2型糖尿病患者经皮冠状动脉介入术(PCI)术后抗血小板治疗的影响。方法选取2018年1月至2019年3月郑州大学附属洛阳中心医院心内科住院治疗的120例CHD合并2型糖尿病并行PCI的患者,输血科收集患者资料,按照是否服用二甲双胍分为二甲双胍组(n=45)和非二甲双胍组(n=75),男86例,女34例,年龄(62.55±11.71)岁,年龄范围为36~87岁。二甲双胍组在常规治疗的基础上加用二甲双胍,非二甲双胍组仅实施常规治疗。分析两组患者的一般情况、二磷酸腺苷(ADP)抑制率、血小板纤维蛋白凝块强度(MAADP)及氯吡格雷抵抗率、花生四烯酸抑制率和阿司匹林抵抗率。结果两组患者体质量指数、空腹血糖、糖化血红蛋白、血小板计数、总胆固醇、甘油三酯、尿酸比较,差异均无统计学意义(P>0.05)。二甲双胍组ADP抑制率[(46.18±21.75)%]高于非二甲双胍组[(37.68±11.90)%],MAADP[(35.91±10.98)mm]、氯吡格雷抵抗率[24.4%(11/45)]低于非二甲双胍组[(44.35±11.71)mm、42.7%(32/75)],差异均有统计学意义(P<0.05)。二甲双胍组花生四烯酸抑制率[(66.86±21.09)%]、阿司匹林抵抗率[17.8%(8/45)]与非二甲双胍组[(69.91±23.25)%、22.7%(17/75)]比较,差异无统计学意义(P>0.05)。结论二甲双胍能够改善CHD合并2型糖尿病患者PCI术后抗血小板药物敏感性,根据病情口服一定剂量的二甲双胍可改善患者远期预后。

Objective To investigate the effect of metformin on antiplatelet therapy after percutaneous coronary intervention(PCI)in patients with coronary atherosclerotic heart disease(CHD)and type 2 diabetes.Methods A retrospective study was performed on 120 cases of patients with CHD combined type 2 diabetes who were admitted and underwent PCI from January 2018 to March 2019.According to whether taking metformin as metformin group(n=45)and metformin group(n=75),86 cases of male,female 34 cases,aged(62.55±11.71)years old,ranging from 36 to 87 years old.The metformin group was treated with metformin in addition to conventional treatment,while the non-metformin group was treated with conventional treatment.The general situation,inhibition rate of adenosine diphosphate(ADP),platelet fibrin clot strength(MAADP)and resistance rate of clopidogrel,inhibition rate of arachidonic acid and resistance rate of aspirin in the two groups were analyzed.Results There were no statistically significant differences in body mass index,fasting blood glucose,hemoglobin a1c,platelet count,total cholesterol,triglyceride and uric acid between the two groups(P>0.05).The inhibition rate of ADP[(46.18±21.75)%]in the metformin group was higher than that in the non-metformin group[(37.68±11.90)%],the resistance rate of MAADP[(35.91±10.98)mm]and clopidogrel[24.4%(11/45)]was lower than that in the non-metformin group[(44.35±11.71)mm and 42.7%(32/75)],with statistically significant differences(P<0.05).The inhibition rate of arachidonic acid in the metformin group[(66.86±21.09)%],the resistance rate of aspirin[17.8%(8/45)]and the non-metformin group[(69.91±23.25)%,22.7%(17/75)]showed no significant difference(P>0.05).Conclusion Metformin can improve the sensitivity of antiplatelet drugs in patients with coronary heart disease complicated with T2DM after PCI,and a certain dose of metformin orally according to the condition may improve the long-term prognosis of patients.