回顾性分析2014年3月至2015年4月,北京大学首钢医院经冠脉造影确诊为冠心病的患者70例,其中分低龄组36例,高龄组34例,均予双联抗血小板治疗。采用血栓弹力图测定血小板抑制率,记录糖化血红蛋白(HbA1c),心肌梗死发生率等疗效及其预后。应用SPSS 15.0软件,计量资料比较采用t检验,计数资料比较采用χ~2检验,以Pearson法检验相关性,logistic回归分析行多因素分析,P<0.05为差异有统计学意义。结果显示,高龄组花生四烯酸(arachidonic acid,AA)抑制率(44.41±3.43)%,低龄组AA抑制率(43.86±3.60)%,差异无统计学意义(χ~2=-0.065,P=0.948)。高龄组二磷酸腺苷(adenosine diphosphate,ADP)抑制率(39.53±16.97)%,低于低龄组ADP抑制率(59.92±21.20)%,差异有统计学意义(χ~2=4.425,P<0.01)。两组间HbA1c差异有统计学意义(χ~2=-7.101,P=0.001),且与ADP抑制率呈负相关(r2=0.333,P<0.05)。高龄组心肌梗死11例(32.35%),低龄组4例(11.11%),差异有统计学意义(χ~2=4.686,P=0.042)。随访期间,两组首发心肌梗死时间差异有统计学意义(χ~2=5.534,P=0.011)。Logistic回归分析显示,HbA1c是老年患者氯吡格雷抵抗的独立危险因素。高龄患者氯吡格雷抵抗的发生率较高,与高龄患者血糖控制不佳相关,不良心血管事件再次发生风险较高。 From March 2014 to April 2015, 70 patients with CHD diagnosed by coronary angiography at Shougang Hospital of Peking University from March 2014 to April 2015 were retrospectively analyzed. Among them, 36 cases were divided into young group and 34 cases in advanced group, all of whom were treated with dual antiplatelet therapy. Thromboelastography was used to determine the inhibition rate of platelet. The therapeutic effect and prognosis of HbA1c and myocardial infarction were recorded. SPSS15.0 software was used to compare the measurement data using t test, count data were compared usingχ ~ 2 test to Pearson test correlation, logistic regression analysis of multivariate analysis, P <0.05 for the difference was statistically significant. The results showed that the inhibitory rate of arachidonic acid (AA) in elderly patients was (44.41 ± 3.43)%, and that in young patients was (43.86 ± 3.60)%, the difference was not statistically significant (χ ~ 2 = -0.065, P = 0.948). The inhibitory rate of adenosine diphosphate (ADP) in elderly group was (39.53 ± 16.97)%, lower than that in young group (59.92 ± 21.20%), the difference was statistically significant (χ ~ 2 = 4.425, P <0.01 ). The difference of HbA1c between the two groups was statistically significant (χ ~ 2 = -7.101, P = 0.001), and negatively correlated with ADP inhibition rate (r2 = 0.333, P <0.05). There were 11 cases of myocardial infarction (32.35%) in senior group and 4 cases (11.11%) in younger group (χ ~ 2 = 4.686, P = 0.042). During follow-up, there was significant difference in the time of first myocardial infarction between the two groups (χ ~ 2 = 5.534, P = 0.011). Logistic regression analysis showed that HbA1c was an independent risk factor for clopidogrel resistance in elderly patients. The incidence of clopidogrel resistance in older patients is higher, associated with poor glycemic control in older patients, and the risk of adverse cardiovascular events is high again.