| Objectives:Ischemic stroke has become a kind of disease which the morbidity, mortality anddisability is the highest in the world,and it is even higher than cancer. The rate ofplatelet aggregation plays a key role in cerebral infarction. Diabetic patients oftenhave multiple risk factors for atherosclerosis and thrombosis, includinghypertension, dyslipidemia, obesity, hypercoagulable state, etc. About75%ofdiabetic patients eventually died because of thrombotic diseases.Diabetes can notonly increase incidence and severity of stroke, but also make the age of onset ofstroke ahead. Therefore, antiplatelet therapy in patients with diabetes is particularlyimportant. Recent studies have found that many patients in the use of therapeuticdoses of anti-platelet drugs, cardiovascular and cerebrovascular events still occur, aphenomenon known as anti-platelet drug resistance. In this study,we observed thechange of the rate of platelet aggregation(RPA) before and after taking aspirin,clopidogrel, cilostazol in patients with type2diabetes,and discuss the differences ofthe incidence of three anti-platelet drug resistance and its possible influencingfactors, to provide the basis for choosing rational drugs for cerebral infarction primaryprevention in clinical.Methods:Collected213patients with type2diabetes and were randomly divided into the aspiringroup (n=60), clopidogrel group (n=76) and cilostazol group (n=77). Under thecondition of the stability of the experiment, using the light turbidimetry, three groups ofpatients were separately measured without medication, medication after10days (aspirin100mg/d, clopidogrel75mg/d, cilostazol200mg/d)of the rate of platelet aggregation.Collected68people as the normal control group, measured the rate of plateletaggregation as a reference. We Compared the differences of antiplatelet drug resistancebetween the three groups of patients and compared the demographic and clinical data,used multivariable logistic regression analysis to determine independent risk factors forantiplatelet drug resistance. Results:1. There were10cases (16.7%) occurred to be resistance in aspirin group,16cases (21.1%)in clopidogrel group, and21cases (27.3%) in cilostazol group. The incidence of plateletresistance was no significant difference (P>0.05) in three groups of patients2. The proportion of total cholesterol, LDL, smoking and the history of PCI in aspirinresistance group is higher than aspirin effective group, and the difference was statisticallysignificant (P <0.05). Low-density lipoprotein (OR=3.224,95%CI1.049-9.907, P=0.041)is the independent risk factors for aspirin resistance.3. The proportion of BMI, triglycerides, insulin resistance index, smoking and the history ofPCI in clopidogrel resistance group is higher than clopidogrel effective group, and thedifference was statistically significant (P <0.05). BMI (OR=1.629,95%CI1.143-2.321, P=0.007), triglycerides (OR=22.130,95%CI1.520-322.205, P=0.023), insulin resistanceindex (OR=3.998,95%CI1.494-10.699, P=0.006) is the independent risk factors forclopidogrel resistance.4.4.The proportion of BMI, triglyceride, low density lipoprotein, insulin resistance index,history of coronary heart disease in cilostazol resistance group is higher than cilostazoleffective group, and the difference was statistically significant (P <0.05). BMI (OR=1.404,95%CI1.095-1.800, P=0.007), low density lipoprotein (OR=7.072,95%CI2.053-24.360,P=0.002), insulin resistance index (OR=2.358,95%CI1.123-4.954, P=0.023), historyof coronary heart disease (OR=9.508,95%CI1.368-66.091, P=0.023) is theindependent risk factors for cilostazol resistance.Conclusion:1. No significant statistical difference was found between the incidence of aspirin resistance,clopidogrel resistance and cilostazol resistance in patients with type2diabetes.2. Aspirin resistance is associated with low density lipoprotein; Clopidogrel resistance isassociated with BMI, triglycerides, insulin resistance index; cilostazol resistance isassociated with BMI, low density lipoprotein, insulin resistance index, history of coronaryheart disease. |
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