Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland , Dublin , Ireland.
Platelets. 2012;23(6):439-46. doi: 10.3109/09537104.2011.634932. Epub 2011 Dec 13.
Patients with type 2 diabetes mellitus exhibit considerable platelet dysfunction, though this is poorly characterized in patients with diabetes taking aspirin for the primary prevention of cardiovascular events. We sought to compare platelet function in this patient population with that of a high-risk group of non-diabetic subjects with a history of previous myocardial infarction (MI), and to assess whether glycaemic control impacts on platelet function.
Platelet aggregation was measured in response to incremental concentrations of five platelet agonists using light transmission aggregometry. All patients were taking aspirin, and aspirin insensitivity was defined as ≥ 20% arachidonic acid (AA) mediated aggregation. Patients with diabetes were divided according to glycaemic control (HbA(1c)): optimal ≤ 6.5, good 6.6-7.4 and suboptimal ≥ 7.5%.
In total, 85 patients with type 2 diabetes and 35 non-diabetic patients with previous MI were recruited. Compared to MI patients, diabetes patients had increased aggregation in response to multiple concentrations of epinephrine, collagen, adenosine diphosphate and AA. Aspirin insensitivity was more common in type 2 diabetes (15% vs. 0%, p=0.037). Platelet aggregation was increased in response to several agonists patients with suboptimal glycaemic control compared to patients with optimal control. Aspirin insensitivity was also more common in patients with suboptimal glycaemic control compared to those with good or optimal control (26.0% vs. 8.3% vs. 4%, p=0.04).
Patients with type 2 diabetes mellitus, without proven vascular disease, exhibit platelet dysfunction and have increased platelet aggregation and aspirin insensitivity compared to non-diabetic patients with previous MI. Platelet dysfunction in diabetes is more severe in patients with suboptimal glycaemic control.
患者 2 型糖尿病表现出相当大的血小板功能障碍，尽管在服用阿司匹林进行心血管事件一级预防的糖尿病患者中这种情况描述较差。我们试图比较该患者人群与有既往心肌梗死（MI）病史的高危非糖尿病患者的血小板功能，并评估血糖控制是否影响血小板功能。
使用透光比浊法测量对五种血小板激动剂的递增浓度的血小板聚集。所有患者均服用阿司匹林，将阿司匹林不敏感定义为≥20%的花生四烯酸（AA）介导的聚集。根据血糖控制（HbA（1c））将糖尿病患者分为：理想≤6.5，良好 6.6-7.4 和不理想≥7.5%。
共纳入 85 例 2 型糖尿病患者和 35 例有既往 MI 的非糖尿病患者。与 MI 患者相比，糖尿病患者对多种浓度的肾上腺素、胶原、二磷酸腺苷和 AA 的反应性聚集增加。2 型糖尿病患者的阿司匹林不敏感更为常见（15% vs. 0%，p=0.037）。与血糖控制理想的患者相比，血糖控制不理想的患者对几种激动剂的血小板聚集增加。与血糖控制良好或理想的患者相比，血糖控制不理想的患者的阿司匹林不敏感也更为常见（26.0% vs. 8.3% vs. 4%，p=0.04）。
无明确血管疾病的 2 型糖尿病患者表现出血小板功能障碍，与有既往 MI 的非糖尿病患者相比，血小板聚集和阿司匹林不敏感增加。糖尿病患者的血小板功能障碍在血糖控制不理想的患者中更为严重。
