中国动脉硬化杂志2017，Vol.25Issue(10)：1025-1030,6.
冠心病高血压合并高血糖患者出现氯吡格雷抵抗:涉及血小板ATP含量增高及线粒体膜电位降低
Clopidogrel resistance in coronary artery disease and hypertension patients with high blood sugar: involving increased platelet ATP content and mitochondrial membrane potential decreased
黄婷婷 1苗立夫 1易军 2任艺虹2
作者信息
- 1. 清华大学第一附属医院北京华信医院心内科,北京市100016
- 2. 解放军总医院心内科,北京100853
- 折叠
摘要
Abstract
Aim To find the causes of clopidogrel resistance caused by high blood glucose from the view of platelet energy metabolism by detection of molecular markers.Methods About 122 patients with coronary artery disease (CAD) accompanying hypertension (HPT) were randomly analyzed.The patients were divided into low response group (LRG) and response group (RG) according to the inhibition of their platelet through the way of ADP inhibition rate in thrombelastogram (TEG).19 cases (hyperglycemia group)were randomly selected from the group of LRG with hyperglycemia,and 20 cases (no hyperglycemia group) were randomly selected from the group of RG without diabetes or with normal glucose tolerance test.Fresh platelets were isolated for ATP and mitochondrial membrane potential (Δψm) analysis.ATP contents were determinated by luciferin/luciferase luminometric method,and the flow cytometry technique was adopted to evaluate Δtm.In all participants correlation between platelet ATP content,Δψm and other variables was analyzed by a multivariable stepwise regression.Results Platelet ATP contents were significandy higher in hyperglycemia group (4.369t2.174 mmol/g) than in no hyperglycemia group (1.628+0.452 mmol/g;P＜0.001).Interestingly,Δψm was markedly decreased in patients of hyperglycemia group (0.484±0.118) compared with no hyperglycemia group (2.381+ 0.194;P ＜ 0.001).For whole subjects,a liner stepwise regression showed that plasma glycated hemoglobin A lc (HbAlc) level was positively correlated to platelet ATP content (β =1.235;P=0.000),and negatively correlated to Δψm (β =-0.54;P=0.000).Although,the age of the patients was involved in the regression equation,but significant correlation (β=0.03;P=0.006) was found between Δψm and HbAlc instead of age.Conclusion High blood glucose leads platelet to produce more ATP,resulting in increased platelet activity,making it easier for patients with high blood glucose to develop Clopidogrel resistance (CR).At the same time,high blood glucose reduces the Δψm of platelets,promoted early apoptosis,indirect CR may be induced.关键词
血小板/氯吡格雷抵抗/高血糖/三磷酸腺苷/线粒体膜电位Key words
Platelet/Clopidogrel resistance/High blood glucose/Adenosine triphosphate/Mitochondrial membrane potential分类
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黄婷婷,苗立夫,易军,任艺虹..冠心病高血压合并高血糖患者出现氯吡格雷抵抗:涉及血小板ATP含量增高及线粒体膜电位降低[J].中国动脉硬化杂志,2017,25(10):1025-1030,6.
