我们的网站为什么显示成这样?

可能因为您的浏览器不支持样式,您可以更新您的浏览器到最新版本,以获取对此功能的支持,访问下面的网站,获取关于浏览器的信息:

|本期目录/Table of Contents|

西洛他唑与氯吡格雷对糖尿病患者抗血小板的作用及影响因素的比较

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第5期
页码:
579-582,587
栏目:
临床研究
出版日期:
2014-05-25

文章信息/Info

Title:
Comparison of cilostazol and clopidogrel for antiplatelet effect and influencing factors in patients with diabetes
作者:
高 宇
(内蒙古林业总医院老年病科,内蒙古 牙克石 022150)
Author(s):
GAO Yu
(Department of Geriatrics, Inner Mongolia Forestry General Hospital, Yakeshi 022150, Inner Mongolia, China)
关键词:
氯吡格雷西洛他唑糖尿病比较
Keywords:
clopidogrel cilostazol diabetes
分类号:
R587.1
DOI:
-
文献标识码:
A
摘要:
目的:探讨西洛他唑与氯吡格雷对糖尿病患者血小板聚集率的作用及其可能影响因素。方法: 选择糖尿病患者1 153例,随机分为西洛他唑组(n=577)和氯吡格雷组(n=576),分别在治疗前及治疗1周后测定血小板聚集率,比较两组患者治疗前后血小板聚集率的变化差异,以及比较血脂、空腹血糖、空腹胰岛素、糖化血红蛋白、胰岛素使用剂量对血小板聚集率的影响。结果: ①西洛他唑组服药前后血小板聚集率变化为(19±17)%,氯吡格雷组服药前后血小板聚集率的变化为(21±14)%,两组血小板聚集率的变化无显著差异,氯吡格雷与西洛他唑疗效相同。②三酰甘油、胰岛素使用剂量均为西洛他唑抵抗发生的独立危险因素,低密度脂蛋白胆固醇、胰岛素使用剂量为氯吡格雷抵抗发生的独立危险因素。结论: 对于糖尿病患者使用西洛他唑预防心脑血管事件可能要优于氯吡格雷。
Abstract:
AIM:To investigate the effect of clopidogrel and cilostazol on platelet aggregation rate (PAR) in patients with type 2 diabetes mellitus (T2DM) and the possible factors that influence their effect. METHODS: There were 1 153 patients with T2DM who were randomly divided into two groups: clopidogrel group (n=576) and cilostazol group (n=577). PAR was detected at baseline and 1 week after medication. PARs were compared between groups and the factors affecting PAR such as lipids, fasting glucose, fasting insulin, glycosylated hemoglobin and dosage of insulin were examined. RESULTS: The changes of PAR before and after medication were (19±17)% in clopidogrel group and (21±14)% in cilostazol group, with no significant difference between groups, suggesting that clopidogrel and cilostazol achieved a similar effect on PAR rate. Low-density lipoprotein and insulin dose were the independent risk factors of clopidogrel resistance, whereas triglycerides and insulin dose were independent risk factors of cilostazol resistance. CONCLUSION: Cilostazol may be superior to clopidogrel in preventing cardio/cerebrovascular events in patients with diabetes.

参考文献/References

[1]Gurbel PA,Bliden KP,Hiatt BL,et al.Clopidogrel for coronary stenting response variability,drug resistance, and the effect of pretreatment platelet reactivity[J].Circulation,2003,107(23):2908-2913.
[2]Mega JL,Close SL,Wiviott SD,et al.Cytochrome p-450 polymorphisms and response toclopidogrel[J].N Engl J Med,2009,360(4):354-362.
[3]Geiger J,Brich J,Honig-Liedl P,et al.Specific impairment of human platelet P2Y(AC)ADP receptor-mediated signaling by the antiplatelet drug clopidogrel[J].Arteriosder Thromb Vasc Biol,1999,19(8):2007-2011.
[4]Kimura Y,Tani T,Kanbe T,et al.Effect of cilostazol on platelet aggregation and experimental thrombosis[J].Forsch Drug Res,1985,35(7A):1144-1149.
[5]徐 静,齐国先.西洛他哇与氯咄格雷对冠心病不稳定性心绞痛患者的抗血小板疗效比较[J].中华心血管病杂志,2004,32(2):289.
[6]Lee SW,Park SW,李天霞.成功置入冠状动脉支架后使用西洛他唑和氯吡格雷的对比研究[J].世界核心医学期刊文摘(心脏病学),2005,7(1):859-862.
[7]Kim JS,Lee KS,Kim YI,et al.A randomized crossover comparative study of aspirin ,cilostazol and clopidogrel in normal controls:analysis with quantitative bleeding time and platelet aggregation test[J].J Clin Neurosci,2004,11(6):600-602.
[8]Ishiguro M,Mishiro K,Fujiwara Y,et al.Phosphodiesterase-III inhibitor prevents hemorrhagic transformation induced by focal cerebral ischemia in mice treated with Tpa[J].PLoS One,2010,5(12):e15178.
[9]Kasahara Y,Nakagomi T,Matsuyama T,et al.Cilostazol reduces the risk of hemorrhagic infarction after administration of tissue -type plasminogen activator in a murine stroke model[J].Stroke,2012,43(2):499-506.
[10]Hase Y,Okamoto Y,Fujita Y,et al.Cilostazol,a phosphodiesterase inhibitor,prevents no-reflow and hemorrhage in mice with focal cerebral ischemia[J].Exp Neurol,2012,233(1):523-533.
[11]Stone WM,Demaerschalk BM,Fowl RJ,et al.Type 3 phosphodiesterase inhibitors may be protective against cerebrovascular events in patients with claudication[J].J Stroke Cerebrovasc Dis,2008,17(3):129-133.
[12]von Beckerath N,von Beckerath O,Koch W,et al.P2Y12 gene H2 haplotype is not associated with in-creased adenosine diphosphate-induced platelet aggregation after initiation of clopidogrel therapy with a high loading dose[J].Blood Coagul Fibrinol,2005,16 (3):199-204.
[13]Lev EI,Patel RT,Guthikonda S,et al.Genetic polymorphismsof the platelet receptors P2Y(12), P2Y(1)and GP IIIa and response to aspirin and clopidogrel[J].Thromb Res,2007,119(3):355-360.
[14]The World Health Organization MONICA project (monitoring trends and determinants in cardiovascular disease): a major international collabo- ration.WHO MONICA project principal investigators[J].J Clin Epidemiol,1988,41(2):105-114.
[15]石红婷,周伯荣,王 融,等.氯吡格雷抵抗在脑梗死患者中的动态观察[J].中国卒中杂志,2012,11(7):852-857.
[16]Ferreira IA,Mocking AI,Feijge MA,et al.Platelet inhibition by insulin is absent in type 2 diabetes mellitus[J].Arterioscler Thromb Vasc Biol,2006,26(2):417-422.
[17]Ferreira IA,Eybrechts KL,Mocking AI,et al.IRS-1 mediates inhibition of Ca2+ mobilization by insulin via the inhibitory G-protein Gi[J].J Biol Chem,2004,279(5):3254-3264.
[18]Angiolillo DJ,Bernardo E,Ramirez C,et al.Insulin therapy is associated with platelet dysfunction in patients with type 2 diabetes mellitus on dual oral antiplatelet treatment[J]. J Am Coll Cardiol,2006,48(2):298-304.
[19]杨 光,高 政.胰岛素抵抗与急性脑梗死发病的相关性研究[J].中华全科医师杂志,2010,9(12):877-878.
[20]Hara Y.Deep venous thrombosis in stroke patients during rehabilitation phase[J].Keio J Med,2008,57(4):196-204.

备注/Memo

备注/Memo:
收稿日期:2013-10-11.
作者简介:高宇,主治医师,硕士 Email:gaoyugaoyu1980@163.com
更新日期/Last Update: 2014-06-05