糖尿病患者的小剂量阿司匹林抵抗发生率高

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Diabetes Affects Prevalence of Aspirin Resistance at Low Doses: Presented at ACC
By Danny Kucharsky
ACC报道：糖尿病患者的小剂量阿司匹林抵抗发生率高

NEW ORLEANS, LA -- March 28, 2007 -- Low-dose aspirin may not provide adequate platelet inhibition in diabetic patients, according to results of a study presented here at the 56th annual scientific session of the American College of Cardiology (ACC).
新奥尔良，2007－3－28，――根据一项在美国心脏病学会第56届学术年会上报道的研究结果表明，在糖尿病患者中小剂量的阿司匹林也许不能提供足够的血小板抑制作用。

The double-blind, double crossover study presented on March 26th, aimed to determine the effects of 3 doses of aspirin on platelet aggregation in diabetics and nondiabetics.
在3月26日发表的这项双盲双交叉研究目的在于确定三种剂量的阿司匹林对于糖尿病患者和非糖尿病患者的抗血小板聚集作用的效果。

According to lead investigator Dr. Paul Gurbel, MD, director, Sinai Centre for Thrombosis Research, Baltimore, Maryland, United States, the optimal dose of aspirin to prevent heart attacks in patients with diabetes has never been studied.
根据美国马里兰州Baltimore的西奈凝血研究中心主管，首席研究员，医学博士Paul Gurbel所说，至今还没有研究来确定在糖尿病患者中预防心脏病发作的最合适阿司匹林剂量是多少。

In the study, 120 patients (30 with diabetes) with stable coronary artery disease were randomly assigned to receive progressive aspirin doses of 81 mg (low dose), 162 mg, or 325 mg of daily for 4 weeks each, for a total of 12 weeks.
在这项研究中，120位稳定性冠心病病人（其中30位有糖尿病）被随机的分成三组，然后在三个阶段分别接受三种不同的阿司匹林剂量，即每天81 mg（低剂量），162 mg, 和325 mg。每一个阶段持续4周，接着就进行交叉互换，总的实验时间是12周。

Platelet aggregation was evaluated extensively at the end of each 4-week period. Responses to aspirin were measured by cyclooxygenase 1 (COX-1)-specific assays and COX-1 nonspecific assays.
在一个为期4周的阶段结束时都要进行血小板聚集功能的评估。人体对于阿司匹林的反应是通过环氧和酶1(COX-1)特异性测定法和COX-1非特异性测定法来进行测量的。

The overall prevalence of aspirin resistance was below 5% during the 81 mg aspirin treatment period using direct measurement of COX-1 inhibition. Resistance at 81 mg was much higher in diabetic patients when measured by indirect measurements of COX-1, including the levels of adenosine diphosphate (ADP; 27% in diabetics vs 14% in nondiabetics, P = .052), collagen-induced aggregation (27% vs 4%, P = .002), point-of-care VerifyNow aspirin assay (13% vs. 3%, P = .02) and urinary thromboxane levels (37% vs. 17%, P = .02).
在81 mg阿司匹林治疗阶段中运用COX-1抑制直接测量法测得阿司匹林抵抗总的发生率低于5％。当应用COX-1非直接测量法测量时，糖尿病患者的小剂量阿司匹林抵抗发生率更高，它具体包括二磷酸腺苷水平（ADP; 糖尿病病人27% vs非糖尿病病人14%, P =0.052)，胶原诱导的聚集（27% vs 4%, P =0.002)，VerifyNow床边阿司匹林测定(13% vs 3%, P =0.02)和尿血栓素水平(37% vs 17%, P =0.02)。

Dr. Gurbel noted that \"in general, increasing the dose of aspirin in the diabetic patient reduces the prevalence of resistance to a level observed in the nondiabetic patient.\" At a 325 mg daily dose, for example, collagen-induced platelet aggregation fell significantly, from 54% to 29% among diabetics (P < .001).
Gurbel博士指出“总的来说，增加糖尿病患者服用阿司匹林的剂量就可以使阿司匹林抵抗发生率降低到非糖尿病病人的水平。”例如，每天服用325 mg阿司匹林，糖尿病患者的胶原诱导的血小板聚集就明显的从54％降到了29％。

However, Dr. Gurbel said the researchers did not observe a dose-dependent effect of aspirin in ADP-induced aggregation in diabetic patients. This suggests a potential benefit of using ADP-receptor blockers in addition to higher-dose aspirin in selected diabetic patients.
然而，Gurbel博士说研究人员在糖尿病患者身上并没有观察到针对ADP诱导聚集的阿司匹林剂量依赖效应。这就表明如果在糖尿病患者身上联合应用ADP受体拮抗剂和大剂量阿司匹林，可能会收到意想不到的回报。

Future large scale studies are needed to evaluate the clinical efficacy of higher aspirin doses in diabetic patients and the impact of diabetes and other variables on the responsiveness of platelets to aspirin and accurate dosing, said Dr. Gurbel.
Gurbel博士说未来还需要一些大规模的研究来评估糖尿病患者服用更大剂量阿司匹林的临床效力，糖尿病和其它因素对于血小板对阿司匹林反应性的影响以及阿司匹林最合适的剂量。