Angiolillo Dominick J, Fernandez-Ortiz Antonio, Bernardo Esther, Ramírez Celia, Sabaté Manel, Jimenez-Quevedo Pilar, Hernández Rosana, Moreno Raul, Escaned Javier, Alfonso Fernando, Bañuelos Camino, Costa Marco A, Bass Theodore A, Macaya Carlos
Division of Cardiology, University of Florida, Shands Jacksonville, 655 West 8th St., Jacksonville, FL 32209, USA.
Diabetes. 2005 Aug;54(8):2430-5. doi: 10.2337/diabetes.54.8.2430.
To assess platelet function profiles in diabetic and nondiabetic patients on aspirin and clopidogrel therapy, two patient populations were included to investigate the 1) acute effects of a 300-mg clopidogrel loading dose (group 1, n = 52) and 2) long-term effects of clopidogrel (group 2, n = 120) on platelet function in diabetic compared with nondiabetic patients already on aspirin treatment. Patients were stratified according to the presence of type 2 diabetes. Platelet aggregation was assessed using light transmittance aggregometry (groups 1 and 2). Platelet activation (P-selectin expression and PAC-1 binding) was determined using whole-blood flow cytometry (group 2). Clopidogrel response was also assessed. In group 1, platelet aggregation was significantly increased in diabetic (n = 16) compared with nondiabetic (n = 36) patients at baseline and up to 24 h following a 300-mg loading dose (P = 0.005). In group 2, platelet aggregation and activation were increased in diabetic (n = 60) compared with nondiabetic (n = 60) subjects (P < 0.05 for all platelet function assays). Diabetic subjects had a higher number of clopidogrel nonresponders (P = 0.04). Diabetic patients have increased platelet reactivity compared with nondiabetic subjects on combined aspirin and clopidogrel treatment. Reduced sensitivity to antiplatelet drugs may contribute to the increased atherothombotic risk in diabetic patients.
为评估接受阿司匹林和氯吡格雷治疗的糖尿病和非糖尿病患者的血小板功能特征，纳入了两个患者群体，以研究：1）300毫克氯吡格雷负荷剂量的急性效应（第1组，n = 52），以及2）与已接受阿司匹林治疗的非糖尿病患者相比，氯吡格雷对糖尿病患者血小板功能的长期效应（第2组，n = 120）。患者根据2型糖尿病的存在情况进行分层。使用透光率聚集法评估血小板聚集（第1组和第2组）。使用全血流式细胞术测定血小板活化（P-选择素表达和PAC-1结合）（第2组）。还评估了氯吡格雷反应。在第1组中，与非糖尿病患者（n = 36）相比，糖尿病患者（n = 16）在基线时以及300毫克负荷剂量后长达24小时的血小板聚集显著增加（P = 0.005）。在第2组中，与非糖尿病受试者（n = 60）相比，糖尿病患者（n = 60）的血小板聚集和活化增加（所有血小板功能测定的P < 0.05）。糖尿病受试者中氯吡格雷无反应者的数量更多（P = 0.04）。与接受阿司匹林和氯吡格雷联合治疗的非糖尿病受试者相比，糖尿病患者的血小板反应性增加。对抗血小板药物敏感性降低可能导致糖尿病患者动脉粥样硬化血栓形成风险增加。
