CAJ | 학술논문

目的：分析合并2型糖尿病的稳定性心绞痛患者血栓弹力图检测结果。 　　方法：随机抽取阜外心血管病医院2012-01至2013-06行冠状动脉造影并置入支架的稳定性心绞痛患者360例，按照是否合并2型糖尿病分为糖尿病组（n=109）和非糖尿病组（n=251），两组患者经常规术前检查、药物治疗和冠状动脉支架置入，入院后行常规检查及血栓弹力图检测。分析血栓弹力图各指标在两组间的差异。 　　结果：糖尿病组年龄、男性占比例、高血压病史占比例、高脂血症占比例和高敏C反应蛋白显著高于非糖尿病组（P<0.05）,单因素回归分析显示，糖尿病与二磷酸腺苷抑制率显著相关（r=0.977，P=0.0001）,与花生四烯酸抑制率相关性不显著（r=0.245，P=0.069）；多因素回归分析显示，在控制上述组间有统计学差异的各因素之后，糖尿病与二磷酸腺苷抑制率仍显著相关（r=0.862，P=0.0001）。两组患者的血栓弹力图主要参数，包括R值、K值、α角和Ma值均有显著统计学差异（P<0.05）；花生四烯酸抑制率在两组间无显著差异（P=0.057），而二磷酸腺苷抑制率在两组有显著统计学差异（P=0.0001）；且糖尿病组氯吡格雷抵抗的发生率显著高于非糖尿病组（34.7%vs 16.2%，P=0.001）。 　　结论：合并糖尿病的稳定性心绞痛患者呈现高凝状态，且氯吡格雷抵抗发生率高，提示冠状动脉介入术后需要加强抗血小板治疗以减少心血管事件。
목적：분석합병2형당뇨병적은정성심교통환자혈전탄력도검측결과。 　　방법：수궤추취부외심혈관병의원2012-01지2013-06행관상동맥조영병치입지가적은정성심교통환자360례，안조시부합병2형당뇨병분위당뇨병조（n=109）화비당뇨병조（n=251），량조환자경상규술전검사、약물치료화관상동맥지가치입，입원후행상규검사급혈전탄력도검측。분석혈전탄력도각지표재량조간적차이。 　　결과：당뇨병조년령、남성점비례、고혈압병사점비례、고지혈증점비례화고민C반응단백현저고우비당뇨병조（P<0.05）,단인소회귀분석현시，당뇨병여이린산선감억제솔현저상관（r=0.977，P=0.0001）,여화생사희산억제솔상관성불현저（r=0.245，P=0.069）；다인소회귀분석현시，재공제상술조간유통계학차이적각인소지후，당뇨병여이린산선감억제솔잉현저상관（r=0.862，P=0.0001）。량조환자적혈전탄력도주요삼수，포괄R치、K치、α각화Ma치균유현저통계학차이（P<0.05）；화생사희산억제솔재량조간무현저차이（P=0.057），이이린산선감억제솔재량조유현저통계학차이（P=0.0001）；차당뇨병조록필격뢰저항적발생솔현저고우비당뇨병조（34.7%vs 16.2%，P=0.001）。 　　결론：합병당뇨병적은정성심교통환자정현고응상태，차록필격뢰저항발생솔고，제시관상동맥개입술후수요가강항혈소판치료이감소심혈관사건。
Objective: To analyze the thromboelastography (TEG) outcomes in patients with stable angina pectoris (SAP) combining diabetes mellitus (DM). Methods: A total of 360 SAP patients treated in our hospital by percutaneous coronary intervention (PCI) from 2012-01 to 2013-06 were randomized into 2 groups:SAP+DM group, n=109 and SAP-DM group, n=251. Routine clinical examination and TEG test were performed and compared between 2 groups. Results: Compared with SAP-DM group, SAP+DM group showed the higher ratios of male gender, history of hypertension, hyperlipidemia and higher level of hs-CRP, all P<0.05. Single regression analysis indicated that DM was related to adenosine diphosphate (ADP) inhibition rate (r=0.977, P=0.0001), not related to arachidonic acid (AA) inhibition rate (r=0.245, P=0.069). Multi regression analysis presented that with controlled relevant factors, DM was still related to ADP inhibition rate (r=0.862, P=0.0001). The major TEG parameters as R value, K value,α-angle and MA value were obviously different between 2 groups, P<0.05, while the AA inhibition rate was similar, P=0.057. ADP inhibition rate was different between 2 groups, P=0.0001. The incidence of clopidogrel resistance was higher in SAP+DM group than that in SAP-DM group (34.7%vs 16.2%, P=0.001). Conclusion: The SAP patients combining DM were at hyper-coagulation status with higher incidence of clopidogrel resistance, who needed intensive post-operative anti-platelet therapy.