冠心病合并糖尿病患者经皮冠状动脉介入治疗后氯吡格雷低反应的发生率及危险因素

Incidence of low response of Clopidogrel and its risk factors in patients with coronary heart disease and type 2 diabetes treated with percutaneous coronary intervention

目的评价择期经皮冠状动脉介入治疗的冠心病合并2型糖尿病患者中氯吡格雷低反应的发生率及危险因素。方法采用回顾性病例对照研究,选取2015年1~9月于首都医科大学附属北京安贞医院行经皮冠状动脉介入治疗的冠心病合并2型糖尿病患者210例,所有患者均于术前至少6 h给予负荷量的氯吡格雷300 mg,分别于服药前及服药至少24 h后取血,光学比浊法测定二磷酸腺苷(ADP)诱导的血小板聚集率。服药前血小板聚集率与服药后血小板聚集率绝对差值≤10%定义为氯吡格雷低反应,据此将患者分为正常组(n=133)和低反应组(n=77),计算氯吡格雷低反应的发生率,并分析年龄、性别、吸烟、血压、血脂、糖化血红蛋白等指标与氯吡格雷低反应的相关性。结果经皮冠状动脉介入术后的冠心病合并2型糖尿病患者中氯吡格雷低反应的发生率为36.67%。低反应组和正常组ADP诱导的血小板聚集率在基线水平差异无统计学意义(P>0.05),在服药24 h后测定分别为(62.62±9.23)%与(32.71±11.77)%,两组间差异有高度统计学意义(P<0.01)。多因素Logistic回归分析结果显示,高糖化血红蛋白水平是氯吡格雷低反应的独立危险因素(P=0.037,OR=1.241,95%CI 1.013~1.519)。结论高糖化血红蛋白水平是冠心病合并糖尿病患者中氯吡格雷低反应的独立危险因素。冠心病合并糖尿病患者中氯吡格雷低反应显著发生,控制糖化血红蛋白在临床上至关重要。

Objective To assess the incidence of low response of Clopidogrel and its risk factors in patients with coronary heart disease and type 2 diabetes treated with percutaneous coronary intervention(PCI). Methods A retrospective case-control study was adopted in this study. 210 patients with coronary heart disease and type 2 diabetes who underwent selective PCI in Beijing Anzhen Hospital Affiliated to Capital Medical University from January to September 2015 were selected. All patients received a loading dose of Clopidogrel 300 mg at least 6 h before PCI. All the patients were taken blood samples before Clopidogrel administration as the baseline and at least 24 h post-medication. ADP induced platelet aggregation was measured by light transmittance aggregometry. Low response of Clopidogrel was defined as the absolute difference of the platelet between baseline and post-medication ≤10%. The patients were divided into the normal group(n=133) and the low-response group(n=77), the incidence of low response of Clopidogrel was calculated,and the correlation between age, gender, smoking, blood pressure, blood lipid, Hb A1 cand low response of Clopidogrel was analyzed. Results The incidence of low response of Clopidogrel in patients with coronary heart disease and type 2diabetes after selective PCI was 36.67%. There was no significance in the ADP induced platelet aggregation rates between the normal group and the low-response group at baseline(P > 0.05); the platelet aggregation rates of the two groups on 24 h post-medication were(62.62 ±9.23)% and(32.71 ±11.77)% respectively, there was significant difference between two groups(P < 0.01). Multivariate Logistic regression analysis found that high level of Hb A1 cwas an independent risk factor of low response of Clopidogrel(P =0.037, OR =1.241, 95% CI 1.013-1.519).Conclusion High level of Hb A1 cis an independent risk factor of low response of Clopidogrel in patients with coronary heart disease and type 2 diabetes. Low response of Clopidogrel exists significantly in patients with coronary heart disease and type 2 diabetes, making controlled levels of Hb A1 cis clinically crucial.