Singla Anand, Antonino Mark J, Bliden Kevin P, Tantry Udaya S, Gurbel Paul A
Sinai Center for Thrombosis Research, Baltimore, MD 21215, USA.
Am Heart J. 2009 Nov;158(5):784.e1-6. doi: 10.1016/j.ahj.2009.08.013.
High platelet reactivity (HPR) during aspirin and clopidogrel therapy in patients with diabetes has been reported and may affect outcomes. However, the relation of platelet reactivity to glycemic control is less studied in patients on dual antiplatelet therapy.
Platelet aggregation (PA) in response to 5 and 20 micromol/L adenosine diphosphate (ADP) was compared in type 2 diabetic (n = 36) and nondiabetic patients (n = 35) undergoing elective stenting on aspirin and clopidogrel maintenance therapy. The relation of glycosylated hemoglobin (HbA(1c)) <7 g/dL (n = 16) and HbA(1c) > or =7 g/dL (n = 20) on PA was examined. High platelet reactivity was defined as >46% for 5 micromol/L ADP-induced and >59% for 20 micromol/L ADP-induced PA.
Diabetic patients had higher 5 and 20 micromol/L ADP-induced PA than nondiabetic patients (45 +/- 17 vs 33 +/- 12, P = .009 and 52 +/- 19 vs 40 +/- 12, P = .004, respectively). Diabetic patients with HbA(1c) > or =7.0 g/dL had significantly higher 5 and 20 micromol/L ADP-induced PA versus patients with diabetes with HbA(1c) <7.0 g/dL (54 +/- 15 vs 34 +/- 14, P < .001 and 62 +/- 14 vs 40 +/- 17, P < .001, respectively). Among diabetic patients with HbA(1c) > or =7 g/dL, the prevalence of HPR was 65% and 60%; and among diabetic patients with HbA(1c) <7 g/dL, the prevalence of HPR was 19% and 13% as measured by 5 and 20 micromol/L ADP-induced PA, respectively. A correlation was present between 5 and 20 micromol/L ADP-induced PA and HbA(1c) (r = 0.60 and 0.62, P = .0001, respectively).
An important relation exists between glycemic control and platelet reactivity in patients with type 2 diabetes mellitus treated with dual antiplatelet therapy. Poorly controlled patients with diabetes have the greatest platelet reactivity and may require alternative antiplatelet strategies, and further clinical investigations are warranted.
有报道称糖尿病患者在接受阿司匹林和氯吡格雷治疗期间存在高血小板反应性（HPR），这可能会影响治疗结果。然而，在接受双联抗血小板治疗的患者中，血小板反应性与血糖控制之间的关系研究较少。
比较了接受择期支架置入术并正在接受阿司匹林和氯吡格雷维持治疗的2型糖尿病患者（n = 36）和非糖尿病患者（n = 35）对5和20 μmol/L二磷酸腺苷（ADP）的血小板聚集（PA）情况。研究了糖化血红蛋白（HbA1c）<7 g/dL（n = 16）和HbA1c≥7 g/dL（n = 20）对PA的影响。高血小板反应性定义为5 μmol/L ADP诱导的PA>46%以及20 μmol/L ADP诱导的PA>59%。
糖尿病患者5和20 μmol/L ADP诱导的PA高于非糖尿病患者（分别为45±17对33±12，P = 0.009；52±19对40±12，P = 0.004）。HbA1c≥7.0 g/dL的糖尿病患者5和20 μmol/L ADP诱导的PA显著高于HbA1c<7.0 g/dL的糖尿病患者（分别为54±15对34±14，P<0.001；62±14对40±17，P<0.001）。在HbA1c≥7 g/dL的糖尿病患者中，5和20 μmol/L ADP诱导的PA测量下HPR的患病率分别为65%和60%；而在HbA1c<7 g/dL的糖尿病患者中，该患病率分别为19%和13%。5和20 μmol/L ADP诱导的PA与HbA1c之间存在相关性（r分别为0.60和0.62，P = 0.0001）。
在接受双联抗血小板治疗的2型糖尿病患者中，血糖控制与血小板反应性之间存在重要关系。血糖控制不佳的糖尿病患者血小板反应性最高，可能需要替代抗血小板策略，有必要进行进一步的临床研究。
