摘要
目的探讨糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平与急性心肌梗死接受直接冠状动脉介入治疗患者术后出现氯吡格雷抵抗的关系。方法急性心肌梗死住院行直接冠状动脉介入治疗患者765例,根据血小板聚集抑制率结果分为抵抗组211例和对照组554例,比较2组临床特点,分析HbA1c对氯吡格雷抵抗的影响。结果 2组年龄、男性、高血压、吸烟、急性前壁心肌梗死比例、发病至就诊时间、白细胞及血小板计数、C反应蛋白水平、梗死相关动脉、术前TIMI血流0级、术后无复流或慢血流及住院期间应用药物比例比较差异均无统计学意义(P>0.05);抵抗组糖尿病、HbA1c水平及急性、亚急性支架内血栓发生率明显高于对照组(P<0.05);糖尿病(OR=2.525,95%CI:0.887～4.136,P=0.029)、HbA1c≥6.5%(OR=1.992,95%CI:0.925～3.879,P=0.027)是直接冠状动脉介入术后出现氯吡格雷抵抗的独立影响因素。结论糖尿病和HbA1c升高与直接冠状动脉介入术后出现氯吡格雷抵抗密切相关。
Objective To explore the relationship of glycosylated hemoglobin （HbAlc） with clopidogrel resistance in patients with acute myocardial infarction after primary percutaneous coronary intervention （PPCI）. Methods A total of 765 AMI patients undergoing PPCI were divided into clopidogrel resistance group （n= 211） and control group （n= 554） according to inhibition rates of platelet aggregation, and the clinical data were compared to analyze the influence of HbA1 c on clopidogrel resistance. Results There were no significant differences in age, gender, hypertension, smoking, acute anterior wall myocardial infarction, length of time from onset to admission, white blood cell count, blood platelet count, C reactive protein, infarction related artery, preoperative TIMI 0 flow, the rate of no reflow/slow flow and usage of drug for treating between two groups （P〉0.05）. Diabetes mellitus, HbA1 c level, the occurrence of acute and subacute stent thrombosis were higher in clopidogrel resistance group than those in control group （P〈0.05）. Logistic analysis showed that diabetesmellitus （OR--2.525, 95%CI： 0.887 to 4. 136, P=0.029） and HbAlc ≥6.5% （OR=1.992, 95%CI： 0. 925 to 3. 879, P= 0. 027） were independent factors for elopidogrel resistance after PPCI. Conclusion Diabetes mellitus and increased HbA1 c level are closely correlated with clopidogrel resistance after PPCI.
出处
《中华实用诊断与治疗杂志》
2013年第3期250-252,共3页
Journal of Chinese Practical Diagnosis and Therapy
基金
首都医科大学基础-临床合作基金(10JL55)
关键词
急性心肌梗死
糖尿病
糖化血红蛋白
直接介入治疗
氯吡格雷抵抗
Acute myocardial infarction
diabetes mellitus
glycosylated hemoglobin
primary percutaneous coronaryintervention
clopidogrel resistance
