Impact of Chronic Kidney Disease on Platelet Function Profiles in Diabetes Mellitus Patients With Coronary Artery Disease Taking Dual Antiplatelet Therapy
Impact of Chronic Kidney Disease on Platelet Function Profiles in Diabetes Mellitus Patients With Coronary Artery Disease Taking Dual Antiplatelet Therapy
复制标题
DOI：
10.1016/j.jacc.2009.10.043
复制
发表时间：
2010-03-16
影响因子：
24
通讯作者：
Fernandez-Ortiz, Antonio
中科院分区：
文献类型：
--
作者：
Angiolillo, Dominick J.;Bernardo, Esther;Fernandez-Ortiz, Antonio
目的：探讨糖尿病（DM）合并冠心病患者服用阿司匹林和氯吡格雷（Clopidogrel）后，肾功能对血小板反应性的影响。在接受阿司匹林治疗的DM患者中，中度/重度CKD的存在与氯吡格雷辅助治疗的临床疗效降低相关。这些发现是否可能归因于氯吡格雷诱导的effects.Methods的差异，这是一个横断面的观察性研究中，糖尿病患者服用维持阿司匹林和氯吡格雷治疗进行了研究。根据是否存在中度/重度CKD，将患者分为2组。采用透光率聚集测定法评估二磷酸腺苷（ADP）和胶原刺激后的血小板聚集，并确定治疗后血小板反应性（HPPR）较高的患者。血小板活化的标志物，包括糖蛋白IIb/IIIa活化和P-选择素的表达，也用流式细胞仪测定。中度/重度CKD患者（n = 84）与无CKD患者（n = 222）相比，ADP诱导的（60 +/- 13% vs. 52 +/-15%，p = 0.001）和胶原诱导的（49 +/- 20% vs. 41 +/-20%，p = 0.004）血小板聚集显著更高。调整潜在混杂因素后，中度/重度CKD患者在ADP（调整后比值比：3.8，95%置信区间：1.7至8.5，p = 0.001）和胶原蛋白（调整后比值比：2.4; 95%置信区间：1.1至5.4; p = 0.029）刺激后更可能发生HPPR。血小板活化标志物显着增加HPPR患者。结论在糖尿病冠心病患者服用维持阿司匹林和氯吡格雷治疗，肾功能受损与氯吡格雷诱导的抗血小板作用减少和HPPR的患病率更高。（J Am科尔心脏病学杂志2010;55：1139-46）（C）美国心脏病学会基金会2010年
Objectives We sought to assess the impact of renal function on platelet reactivity in patients with diabetes mellitus (DM) and coronary artery disease on aspirin and clopidogrel therapy.Background Diabetes mellitus is a key risk factor for chronic kidney disease (CKD). In aspirin-treated DM patients the presence of moderate/severe CKD is associated with reduced clinical efficacy of adjunctive clopidogrel therapy. Whether these findings may be attributed to differences in clopidogrel-induced effects is unknown.Methods This was a cross-sectional observational study in which DM patients taking maintenance aspirin and clopidogrel therapy were studied. Patients were categorized into 2 groups according to the presence or absence of moderate/severe CKD. Platelet aggregation after adenosine diphosphate (ADP) and collagen stimuli were assessed with light transmittance aggregometry and defined patients with high post-treatment platelet reactivity (HPPR). Markers of platelet activation, including glycoprotein IIb/IIIa activation and P-selectin expression, were also determined using flow cytometry.Results A total of 306 DM patients were analyzed. Patients with moderate/severe CKD (n = 84) had significantly higher ADP-induced (60 +/- 13% vs. 52 +/- 15%, p = 0.001) and collagen-induced (49 +/- 20% vs. 41 +/- 20%, p = 0.004) platelet aggregation compared with those without (n = 222). After adjustment for potential confounders, patients with moderate/severe CKD were more likely to have HPPR after ADP (adjusted odds ratio: 3.8, 95% confidence interval: 1.7 to 8.5, p = 0.001) and collagen (adjusted odds ratio: 2.4; 95% confidence interval: 1.1 to 5.4; p = 0.029) stimuli. Markers of platelet activation were significantly increased in patients with HPPR.Conclusions In DM patients with coronary artery disease taking maintenance aspirin and clopidogrel therapy, impaired renal function is associated with reduced clopidogrel-induced antiplatelet effects and a greater prevalence of HPPR. (J Am Coll Cardiol 2010;55:1139-46) (C) 2010 by the American College of Cardiology Foundation