1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Kardiol Pol. 2013;71(9):893-902. doi: 10.5603/KP.2013.0055.
Diabetes mellitus type 2 (DM2) is associated with high platelet reactivity both in patients who do not receive antiplatelet drugs and in those treated with acetylsalicylic acid (ASA). The pathomechanism of this phenomenon has not been fully understood.
We studied 171 patients with DM2 treated with oral antidiabetic drugs and receiving long-term treatment with 75 mg of ASA daily, selected among the participants of the prospective AVOCADO study. Platelet function was simultaneously evaluated using 4 methods: 1. measurement of serum thromboxane B2 (TXB2) concentration; 2. measurement of urinary 11-dehydrothromboxane B2 (11-dhTXB2) concentration; 3. VerifyNow® automated analyser; 4. PFA-100® automated analyser.High platelet reactivity was defined as at least 3 of the following criteria: 1. serum TXB2 concentration in the upper quartile;2. urinary 11-dhTXB2 concentration in the upper quartile; 3. value ≥ 550 aspirin reaction units (ARU) by VerifyNow®;4. collagen-epinephrine closure time (CEPI-CT) below median of readings other than 300 s by PFA-100®. In all patients, DM2 control was evaluated, insulin resistance was measured using HOMA-IR, and routine laboratory tests were performed, including full blood count, renal function parameters, and inflammation markers.
Mean patient age was 67.8 years, and median duration of DM2 was 5 years. We found poor agreement between different tests of platelet function. ARU ≥ 550 (VerifyNow®) was found in 14.0% of patients, and CEPI-CT below median of readings other than 300 s (PFA-100®) was found in 32.8% of patients. Our criteria of high platelet reactivity were met by 9.9% of patients. In multivariate logistic regression analysis, independent predictors of high platelet reactivity despite ASA therapy included chronic heart failure, current smoking, and higher leukocyte count.
2 型糖尿病（DM2）患者无论是否接受抗血小板药物治疗，以及接受乙酰水杨酸（ASA）治疗的患者，血小板反应性均较高。这种现象的发病机制尚未完全阐明。
我们研究了前瞻性 AVOCADO 研究中的 171 名接受口服降糖药治疗并长期接受每日 75mg ASA 治疗的 DM2 患者。同时使用 4 种方法评估血小板功能：1. 测量血清血栓素 B2（TXB2）浓度；2. 测量尿 11-去氢血栓素 B2（11-dhTXB2）浓度；3. VerifyNow®自动分析仪；4. PFA-100®自动分析仪。高血小板反应性定义为符合以下至少 3 项标准：1. 血清 TXB2 浓度处于四分位上限；2. 尿 11-dhTXB2 浓度处于四分位上限；3. VerifyNow®的阿司匹林反应单位（ARU）值≥550；4. PFA-100®的胶原-肾上腺素闭合时间（CEPI-CT）低于 300s 以外的中位数。所有患者均评估 DM2 控制情况，使用 HOMA-IR 测量胰岛素抵抗，进行常规实验室检查，包括全血细胞计数、肾功能参数和炎症标志物。
患者平均年龄为 67.8 岁，DM2 中位病程为 5 年。我们发现不同血小板功能检测之间的一致性较差。ARU≥550（VerifyNow®）在 14.0%的患者中发现，CEPI-CT 低于 300s 以外的中位数（PFA-100®）在 32.8%的患者中发现。我们的高血小板反应性标准在 9.9%的患者中得到满足。多变量逻辑回归分析表明，ASA 治疗后高血小板反应性的独立预测因素包括慢性心力衰竭、当前吸烟和更高的白细胞计数。
