目的：观察急性心肌梗死合并糖尿病且接受直接经皮冠脉介入治疗的患者氯吡格雷抵抗发生的情况及其对远期预后的影响。方法：连续入选2011年1月1日~2012年12月31日在我院接受直接经皮冠脉介入治疗，出院后随访>1年的急性心肌梗死合并糖尿病患者119例，所有患者均在服用氯吡格雷负荷量24 h后进行血栓弹力图检测，根据ADP诱导的血小板抑制率分为对照组(ADP抑制 率≥50%，82例)和观察组(即氯吡格雷抵抗组，ADP抑制率<50%，37例)。记录患者的临床特点、生化指标、随访期间死亡和主要不良心血管事件(main adverse cardiac events，MACE)发生情况。结果：临床随访平均(783±241) d，氯吡格雷抵抗的发生率为31%。随访1年内总的MACE发生率为7.6%。氯吡格雷抵抗组1年内的MACE发生率明显高于对照组(16.2% vs. 3.7%，P=0.025)。氯吡格雷抵抗和长期(1年以上)MACE发生无关(P=0.334)；多因素Cox回归分析，氯吡格雷抵抗对患者的长期死亡率无明显影响。结论：接受直接经皮冠状动脉介入治疗的糖尿病合并急性心肌梗死患者存在明显的氯吡格雷抵抗现象。氯吡格雷抵抗会增加这些患者介入术后1年内发生主要心脏不良事件的风险，而对其1年以上的长期预后无显著影响。
Influence of clopidogrel resistance on prognosis of diabetic patients with acute myocardial infarction treated with percutaneous coronary intervention
Objective: To evaluate the influence of clopidogrel resistance on clinical outcomes of diabetic patients with acute myocardial infarction (AMI) received percutaneous coronary intervention. Methods: A total of 119 diabetic patients with AMI received percutaneous coronary intervention during Jan 2011 to Dec 2012 were enrolled in this study. All patients received standard antiplatelet therapy and platelet inhibition rate induced by adenosine diphosphate (ADP) was tested by thrombelastogram (TEG) after 24 h. According to ADP-induced platelet inhibition rate, the patients were classified into two groups: the study group (clopidogrel resistance group, ratio <50%, n=37) and the control group (ratio ≥50%, n=82). Clinic characteristics, biochemical indicator, death and major adverse cardiac events (MACE) during follow up were recorded. Results: The patients were followed up for a mean of (783±241) days. Clopidogrel resistance was detected in 37 patients (31%) and MACE occurred in 9 patients (7.6%). The incidence of MACE in one year were higher in the clopidogrel resistance group (16.2%) than in the control group (3.7%) (P=0.025). Clopidogrel resistance (P=0.334) was not associated with more than 1 year MACE. After multivariate analysis, clopidogrel resistance was not related with more than 1 year mortality. Conclusion: Clopidogrel resistance is common in the diabetic patients with AMI received percutaneous coronary intervention. Clopidogrel resistance indicates an increased risk of MACE in 1 year and is not associated with more long term (>1 year) prognosis of the patients.