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目的分析冠心病(Coronary Heart Disease CHD)合并糖尿病(diabetes DM)患者阿司匹林抵抗(Aspirin Resistance,AR)的影响因素,评价CHDDM患者AR与主要不良心血管事件(Major adverse cardiovascular events,MACE)和再住院之间的关系。方法选择CHD非糖尿病(no diabetes NDM)的患者136例,CHD合并DM患者134例,记录患者临床情况,测量身高、体重、血压、心率等指标,完善心电图、超声心动图、冠脉造影等检查。检查血常规、凝血功能、生化指标。测定二组患者花生四烯酸(Arachidonic acid,AA)、二磷酸腺苷(Adenosine diphosphate,ADP)诱导的最大血小板聚集率(Maximum platelet aggregation rate,MPAR),评价AR。随访1年,记录患者MACE及再次住院情况。采用Epdate软件建库录入数据资料,应用SPSS 17.0软件进行统计分析。结果 CHDNDM患者与DM患者ADP诱导的MPAR分别为(56.5±19.5)%和(62.1±20.2)%,差异有统计学意义(P<0.05),AA诱导的MPAR分别为(20.1±11.4)%和(26.1±14.7)%。NDM及DM组患者AR分别为46例(33.8%)和84例(62.7%),二组比较差异有统计学意义(χ~2=22.523,P<0.001)。CHDDM患者AR的影响因素包括hs-CRP、LDL-C、UA水平、冠脉严重病变数、介入治疗。随访1年,NDM组和DM组患者发生MACE分别为38例(27.9%)和44例(32.8%),二组比较差异无统计学意义(χ~2=0.765,P=0.428)。再次住院患者42例,NDM及DM组患者再次住院患者分别为18例(13.2%)和24例(17.9%),二组比较差异无统计学意义(χ~2=1.123,P=0.317)。DM非AR组与DMAR组患者MACE分别为8例(16.0%)和36例(42.9%),差异有统计学意义(P<0.05);DM非AR组与DMAR组再次住院患者分别为0例和24例(28.6%),差异有统计学意义(P<0.05)。结论 CHD合并DM患者AR明显增高,AR与hs-CRP、LDL-C、UA水平、冠脉严重病变数、介入治疗有关,DMAR患者MACE及再次住院明显增加。所以对于CHD合并DM患者应该进一步强化抗血小板治疗。
Objective To analyze the influencing factors of Aspirin Resistance (AR) in Coronary Heart Disease (CHD) patients with diabetes mellitus (DM) and evaluate the relationship between AR and major adverse cardiovascular events (MACE) and rehospitalization The relationship between. Methods 136 patients with CHD without diabetes and 134 patients with CHD complicated with DM were enrolled in this study. The clinical conditions, height, weight, blood pressure and heart rate were measured, and electrocardiogram, echocardiography and coronary angiography were performed . Check blood, blood coagulation, biochemical indicators. The maximum platelet aggregation rate (MPAR) induced by arachidonic acid (AA) and adenosine diphosphate (ADP) was measured in two groups of patients and AR was evaluated. Followed up for 1 year, recorded patients MACE and hospitalization again. Using Epdate software to build database to input data and apply SPSS 17.0 software for statistical analysis. Results The MPAR induced by ADP was (56.5 ± 19.5)% and (62.1 ± 20.2)% respectively in CHDNDM patients and DM patients (P <0.05). The MPAR induced by AA was (20.1 ± 11.4)% and (26.1 ± 14.7)%. AR in NDM group and DM group were 46 cases (33.8%) and 84 cases (62.7%) respectively. The difference between the two groups was statistically significant (χ ~ 2 = 22.523, P <0.001). The influencing factors of AR in CHDDM patients include hs-CRP, LDL-C, UA levels, severe coronary artery disease and interventional therapy. One year after follow-up, there were 38 cases (27.9%) and 44 cases (32.8%) of MACE in NDM group and DM group, respectively. There was no significant difference between the two groups (χ ~ 2 = 0.765, P = 0.428). Among the 42 hospitalized patients, there were 18 (13.2%) and 24 (17.9%) hospitalized patients in the NDM and DM groups, respectively. There was no significant difference between the two groups (χ ~ 2 = 1.123, P = 0.317). The MACE of DM non-AR group and DMAR group were 8 cases (16.0%) and 36 cases (42.9%) respectively, the difference was statistically significant (P <0.05); the re-hospitalized patients in DM non-AR group and DMAR group were 0 And 24 cases (28.6%), the difference was statistically significant (P <0.05). Conclusions AR in patients with CHD combined with DM is significantly higher than that in patients with DMAR. The AR and hs-CRP, LDL-C, UA levels, serious coronary lesions, interventional treatment, MACE and rehospitalization were significantly increased. So for CHD patients with DM should further strengthen the anti-platelet therapy.