T2DM合并AMI患者血糖水平与替格瑞洛、氯吡格雷对血小板功能影响的关系

Relationship among ticagrelor and clopidogrel on platelet function and blood glucose level in T2DM+AMI patients

目的:探讨T2DM合并AMI患者血糖水平与替格瑞洛、氯吡格雷对血小板功能影响的关系。方法:我院的250例T2DM合并AMI患者被分为氯吡格雷组(116例)和替格瑞洛组(134例),两组分别接受常规治疗,共治疗12个月,根据患者治疗后血糖控制情况,氯吡格雷组被分为氯-血糖正常(C-NGlu)组(79例)和氯-血糖异常(C-AGlu)组(37例),替格瑞洛组被分为替-血糖正常(T-NGlu)组(88例)和替-血糖异常(T-AGlu)组(46例)。比较各组治疗前后血小板抑制率(PIR)、血浆血小板活化因子CD62p和CD63、纤溶酶原激活抑制物(PAI)-1、组织型纤溶酶原激活剂(t-PA)水平。结果:与C-NGlu组比较,治疗后C-AGlu组PIR[(69.32±19.34)%比(49.30±18.35)%]显著降低,血浆CD62p[(8.30±2.89)%比(12.43±3.98)%]、CD63[(9.34±3.20)%比(14.73±3.57)%]、PAI-1[(0.60±0.08)U/ml比(0.83±0.09)U/ml]、t-PA水平[(155.47±9.75)%比(178.49±8.93)%]均显著升高(P均=0.001);与T-NGlu组比较,治疗后T-AGlu组PIR[(75.46±20.14)%比(65.29±19.06)%]显著降低,血浆CD62p[(8.14±3.75)%比(10.03±3.25)%]、CD63[(9.22±3.19)%比(12.45±3.14)%]、PAI-1[(0.59±0.08)U/ml比(0.72±0.05)U/ml]、t-PA水平[(153.57±8.90)%比(166.74±7.83)%]显著升高(P均<0.01);与C-AGlu组比较,治疗后T-AGlu组PIR[(49.30±18.35)%比(65.29±19.06)%]显著升高,血浆CD62p[(12.43±3.98)%比(10.03±3.25)%]、CD63[(14.73±3.57)%比(12.45±3.14)%]、PAI-1[(0.83±0.09)U/ml比(0.72±0.05)U/ml]、t-PA水平[(178.49±8.93)%比(166.74±7.83)%]显著降低(P均<0.01)。结论:T2DM合并AMI患者的血糖水平控制不佳者氯吡格雷和替格瑞洛的抗血小板作用显著降低,但替格瑞洛抗血小板活性显著好于氯吡格雷。

Objective:To study among ticagrelor and clopidogrel on platelet function and blood glucose level in T2DM+AMI patients.Methods:A total of 250 T2DM+AMI patients of our hospital were divided into clopidogrel group(n=116)and ticagrelor group(n=134),both group all received routine treatment,the treatment course was 12 months.According to blood glucose level after treatment,clopidogrel group was divided into clopidogrel-normal blood glucose group(C-NGlu group,n=79)and clopidogrel-abnormal blood glucose group(C-AGlu group,n=37),and ticagrelor group was divided into ticagrelor-normal blood glucose group(T-NGlu group,n=88)and ticagrelor-abnormal blood glucose group(T-AGlu group,n=46).Platelet inhibition rate(PIR),plasma levels of platelet activating factors:CD62p and CD63,plasminogen activator inhibitor(PAI)-1,and tissue type plasminogen activator(t-PA)were measured and compared among all groups before and after treatment.Results:After treatment,Compared with C-NGlu group,there was significant reduction in PIR[(69.32±19.34)%vs.(49.30±18.35)%],and significant rise in plasma levels of CD62p[(8.30±2.89)%vs.(12.43±3.98)%],CD63[(9.34±3.20)%vs.(14.73±3.57)%],PAI-1[(0.60±0.08)U/ml vs.(0.83±0.09)U/ml]and t-PA[(155.47±9.75)%vs.(178.49±8.93)%]in C-AGlu group(P=0.001 all);Compared with T-NGlu group,there was significant reduction in PIR[(75.46±20.14)%vs.(65.29±19.06)%],and significant rise in plasma levels of CD62p[(8.14±3.75)%vs.(10.03±3.25)%],CD63[(9.22±3.19)%vs.(12.45±3.14)%],PAI-1[(0.59±0.08)U/ml vs.(0.72±0.05)U/ml]and t-PA[(153.57±8.90)%vs.(166.74±7.83)%]in T-AGlu group(P<0.01 all);Compared with C-AGlu group,there was significant rise in PIR[(49.30±18.35)%vs.(65.29±19.06)%],and significant reductions in plasma levels of CD62p[(12.43±3.98)%vs.(10.03±3.25)%],CD63[(14.73±3.57)%vs.(12.45±3.14)%],PAI-1[(0.83±0.09)U/ml vs.(0.72±0.05)U/ml]and t-PA[(178.49±8.93)%vs.(166.74±7.83)%]in T-AGlu group(P<0.01 all).Conclusion:Poor control of blood glucose will significantly reduce antiplatelet effect of clopidogrel and ticagrelor in T2DM+AMI patients,but antiplatelet activity of ticagrelor is significantly stronger than that of clopidogrel.