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目的:分析冠心病(CHD)合并糖尿病(DM)患者氯吡格雷抵抗(CR)及影响因素,评价CR与主要不良心血管事件(MACE)和再住院的关系。方法:选择CHD患者270例,记录患者临床情况及检查结果,测定二磷酸腺苷(ADP)诱导的最大血小板聚集率(MPAR),评价CR。随访1年,记录MACE及再次住院情况.结果:NDM与DM患者CR分别为45(33.1%)例和78例(58.2%),P<0.001,差异有显著性。CHDDM患者CR的影响因素包括心率、TG水平、冠脉严重病变数。随访1年,CS及CR组MACE分别为35例(23.8%)和47例(38.2%),P=0.010,差异有显著性。两组再次住院患者分别为15例(10.2%)和27例(22.0%),P=0.008,差异有显著性。DM组中CR与CS患者MACE的发生分别为32例(41.0%)和12例(21.4%),再次住院病例分别为19例(24.4%)和5例(8.9%),P<0.05,差异有显著性。结论:CHD合并DM患者CR明显增高,CR与心率、TG水平、冠脉严重病变数有关,DM AR患者MACE及再次住院明显增加。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 clopidogrel resistance (CR) and its influencing factors in patients with coronary heart disease (CHD) complicated with diabetes mellitus (DM) and evaluate the relationship between CR and major adverse cardiovascular events (MACE) and rehospitalization. Methods: A total of 270 CHD patients were selected. The clinical conditions and test results were recorded. The maximum platelet aggregation rate (MPAR) induced by adenosine diphosphate (ADP) was measured and CR was evaluated. The patients were followed up for 1 year, MACE and hospitalization were recorded again.Results: The CR of NDM and DM patients were 45 (33.1%) and 78 (58.2%) respectively, P <0.001, the difference was significant. The influencing factors of CR in CHDDM patients include heart rate, TG level and severe coronary artery disease. After one year of follow-up, the MACE of CS and CR patients were 35 (23.8%) and 47 (38.2%) respectively, P = 0.010, with significant difference. There were 15 hospitalizations (10.2%) and 27 cases (22.0%) in the two groups again, P = 0.008, the difference was significant. There were 32 cases (41.0%) and 12 cases (21.4%) of MACE in CR and CS patients respectively in DM group, and 19 cases (24.4%) and 5 cases (8.9%) again were hospitalized again, P <0.05 Significant. CONCLUSIONS: The CR of CHD patients with DM complicated with DM is significantly higher than that of normal controls. CR is associated with heart rate, TG level and severity of coronary artery disease. MACE and hospitalization again significantly increase in patients with DM AR. For CHD patients with DM should further strengthen the anti-platelet therapy.