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目的探讨冠心病合并糖尿病患者行经皮冠状动脉介入治疗后CD62p与氯吡格雷抵抗的相关性研究。方法选择2013年8月—2016年12月在北京市昌平区医院行经皮冠状动脉介入治疗的冠心病合并糖尿病患者150例,所有患者手术前后接受氯吡格雷治疗,比较患者治疗前后血小板聚集率的变化情况,根据血小板聚集率变化的幅度是否≥10%,将患者分为氯吡格雷有效(C2)组和氯吡格雷抵抗(C1)组,分别检测两组患者CD62p以及血小板最大聚集率(PAGM)的水平,并分析其变化与血小板聚集率变化情况的相关性。结果经治疗,患者血小板聚集率较治疗前均显著降低,差异有统计学意义(P<0.05)。根据血小板聚集率下降幅度分为C1组(57例)和C2组(93例),其中C1组患者CD62p较治疗前显著降低,差异有统计学意义(P<0.05);C2组患者CD62p、PAGM较治疗前均显著降低,且变化幅度显著大于C1组,差异有统计学意义(P<0.05);C2组治疗前后CD62p的变化幅度与PAGM下降幅度的相关性(r=0.424,P=0.001)优于C1组(r=0.387,P=0.020)。结论氯吡格雷对冠心病合并糖尿病患者行经皮冠状动脉介入治疗后血小板的活性具有一定的抑制作用,氯吡格雷抵抗可能与血小板活性状态相关。
Objective To investigate the relationship between CD62p and clopidogrel resistance after percutaneous coronary intervention in patients with coronary heart disease complicated with diabetes mellitus. Methods From August 2013 to December 2016, 150 patients with coronary heart disease complicated with diabetes undergoing percutaneous coronary intervention in Changping District Hospital of Beijing were enrolled. All patients received clopidogrel before and after operation. The platelet aggregation rate before and after treatment The patients were divided into clopidogrel effective (C2) group and clopidogrel resistance (C1) group according to whether the change rate of platelet aggregation rate was ≥10%. CD62p and the maximum platelet aggregation rate (PAGM) ) Levels, and analyze the changes and changes in platelet aggregation rate of relevance. Results After treatment, the platelet aggregation rate of patients was significantly lower than that before treatment, the difference was statistically significant (P <0.05). According to the decreasing rate of platelet aggregation, C1 was divided into group C1 (57 cases) and C2 group (93 cases). CD62p in C1 group was significantly lower than that before treatment (P <0.05); CD62p, PAGM (P <0.05). The correlation between the change of CD62p and the decrease of PAGM before and after treatment in C2 group (r = 0.424, P = 0.001) was significantly lower than that in C1 group Superior to C1 group (r = 0.387, P = 0.020). Conclusion Clopidogrel can inhibit the activity of platelets after percutaneous coronary intervention in patients with coronary heart disease and diabetes mellitus. Clopidogrel resistance may be related to the activity of platelets.