双联强化抗血小板对急性冠脉综合征合并糖尿病患者的血小板活性及预后影响被引量：11

Effect of Enhanced Dual Anti-platelet Therapy on Platelet Activity and Prognosis in Patients with Acute Coronary Syndrome and Type 2 Diabetes Mellitus

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摘要目的分析双联强化抗血小板治疗对急性冠脉综合征(ACS)合并2型糖尿病(T2DM)患者的血小板活化功能以及预后的影响。方法选择本院就诊的110例ACS合并T2DM患者进行前瞻性研究,依据随机原则分为:对照组,予以阿司匹林100mg/d及氯吡格雷75mg/d双联抗血小板治疗;观察组,予以阿司匹林100mg/d及替格瑞洛90mg/d双联强化抗血小板治疗。两组均为55例,其他治疗措施依据指南规范应用。检测两组患者的血小板计数(PLT)、血小板活化因子(PAF)及血小板表面标记蛋白CD41、CD62p、CD63水平;检测两组患者血栓弹力图(TEG)各参数(包括R值、K值、α角、MA值和CI值);检测花生四烯酸以及二磷酸腺苷分别诱导的血小板最大聚集率(MARAA和MARADP)。比较两组患者临床疗效的差异。随访一年,比较两组患者主要不良心脏事件(MACE)及各种出血性事件发生率的差异。结果与对照组相比,观察组的PLT、PAF及CD41、CD62p、CD63表达水平显著降低(P<0.05);同时观察组患者的R值、K值以及MARAA和MARADP均明显升高(P <0.05),而α角、MA值和CI值明显降低(P <0. 05)。观察组的总有效率和显效率显著高于对照组(P<0.05)。随访一年,观察组的MACE发生率以及颅内出血、上消化道出血及泌尿道出血等出血性事件发生率均无差异(P>0.05)。结论阿司匹林及替格瑞洛双联强化抗血小板治疗能更好抑制ACS合并T2DM患者血小板活性,临床疗效显著,而不良反应及预后无差异。 Objective To analyze the platelet activity,the clinical effect,the prognosis and the safety for the enhanced dual antiplatelet therapy in patients with acute coronary syndrome(ACS)and type 2 diabetes mellitus(T2DM).Methods A total of 110 patients with ACS and T2DM were collected for the prospective study and divided into two groups randomly:the control group(receiving dual anti-platelet therapy of 100mg/d aspirin and 75mg/d clopidogrel)and the observation group(receiving enhanced dual anti-platelet therapy of 100mg/d aspirin and 90mg/d ticagrelor)with 55 cases in each group.All patients were received standard treatment according to treatment guideline.The indexes of PLT,platelet-activating factor(PAF)and platelet surface marker proteins(CD41,CD62p and CD63)were compared between the two groups.The thrombelastogram(TEG)indexes of R value,K value,αangle,MA value and CI value were detected and compared between the two groups.The indexes of maximum aggregation rate by arachidonic acid(MARAA)and maximum aggregation rate by adenosine diphosphate(MARADP)were compared between the two groups.The indexes of clinical efficacy were compared between the two groups.After one-year of follow-up,the occurrence of the major adverse cardiac events(MACE)and hemorrhagic events were compared between the two groups.Results Compared to the control group,the indexes of PLT and PAF and the surface levels of CD41,CD62p and CD63 in the observation group were lower(P<0.05),and the indexes of R value,K value,MARAA and MARADP in the observation group were higher(P<0.05),and the indexes ofαangle,MA value and CI value were lower(P<0.05).The indexes of total effective rate and significant efficiency rate in the observation group were higher than that in the control group(P<0.05).The recurrence rates of MACE and hemorrhagic events of cerebral hemorrhage,upper gastrointestinal hemorrhage,urinary tract hemorrhage were no different between the two groups(P>0.05).Conclusion The clinical effect of enhanced dual anti-platelet therapy of aspirin and ticagrelor in patients with ACS and T2DM is promising with no significant adverse reactions and outcome.

作者聂珂赵嫦娇 NIE Ke;ZHAO Chang-Jiao(Department of Cardiology,No.163 Hospital of PLA,Changsha 410003,China)

机构地区解放军第一六三医院心血管内科

出处《标记免疫分析与临床》 CAS 2019年第3期380-384,388,共6页 Labeled Immunoassays and Clinical Medicine

关键词急性冠脉综合征 2型糖尿病抗血小板治疗临床疗效预后 Acute coronary syndrome Type 2 diabetes mellitus Anti-Platelet therapy Clinical efficacy Prognosis

分类号 R541.4 [医药卫生—心血管疾病] R587.2 [医药卫生—内分泌]

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参考文献1

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