目的 探讨氯吡格雷抵抗对老年冠状动脉粥样硬化性心脏病(冠心病)合并糖尿病患者的冠状动脉(冠脉)介入治疗预后影响及相关危险因素.方法 选取2012年5月~2016年5月就诊于雅安市人民医院心内科并拟行冠脉介入治疗的年龄>60岁的冠心病合并糖尿病患者248例,根据血栓弹力图的ADP抑制率将其分为研究组和对照组,研究组116例,其中男性68例,女性48例,平均年龄(69.3±8.4)岁;对照组132例,其中男性101例,女性31例,平均年龄(68.7±7.6)岁.对比两组患者的一般临床资料、糖脂代谢、炎症指标及主要不良心血管事件(MACE)发生情况.结果 研究组患者高密度脂蛋白胆固醇(HDL-C)水平明显低于对照组,空腹血浆葡萄糖(FPG)、糖化血清蛋白(GSP)、超敏C反应蛋白(hs-CRP)水平明显高于对照组(P<0.05);研究组术后MACE发生率明显高于对照组(P<0.05);经多元Logistic回归分析,FPG、hs-CRP、HDL-C是影响患者预后的独立危险因素.结论 氯吡格雷抵抗对老年冠心病合并糖尿病患者冠脉介入治疗预后有一定影响,能增加患者术后MACE的发生,FPG、hs-CRP、HDL-C是影响预后的独立危险因素.
Objective To investigate the influence of clopidogrel resistance on prognosis and risk factor analysis in elderly patients with coronary heart disease (CHD) complicated by diabetes after percutaneous coronary intervention (PCI).Methods The patients (aged>60,n=248) were chosen from the Department of Cardiology of People's Hospital of Ya'an City from May 2012 to May 2016, and then divided, according to inhibition rate of thrombelastogram (TEG), into study group (n=116, male 68, female 48 and average age=69.3±8.4) and control group (n=132, male 101, female 31 and average age=68.7±7.6). The clinical materials, glycolipid metabolism, inflammation indexes and incidence of major adverse cardiovascular events (MACE) were compared between 2 groups.Results The level of high-density lipoprotein-cholesterol (HDL-C) was significantly lower, and levels of fasting plasma glucose (FPG), glycated serum protein (GSP) and high sensitivity C-reactive protein (hs-CRP) were significantly higher in study group than those in control group (P<0.05). The incidence of MACE was significantly higher in study group than that in control group (P<0.05). The multi-factor Logistic analysis showed that FPG, hs-CRP and HDL-C were independent risk factors influencing on prognosis.Conclusion Clopidogrel resistance has some influence on prognosis, promote MACE incidence after PCI, and it is the independent risk factors influencing on prognosis in elderly patients with CHD complicated by diabetes.