尿11-脱氢血栓素B2水平与2型糖尿病合并冠心病患者阿司匹林临床疗效的相关性研究
Correlation between the level of the urinary 11-dehydrothromboxane B2 and the clinical efficacy of aspirin in patients with type 2 diabete and coronary artery disease

目的：检测尿中阿司匹林的代谢产物血小板血栓素（11-脱氢血栓素B2，11-dehydrothromboxane B2，11dhTxB2）水平，探讨其与2型糖尿病合并冠心病患者服用阿司匹林临床疗效的相关性。方法：本研究为前瞻性的队列研究，入选169例北京大学第一医院老年内科2型糖尿病合并冠心病的住院患者。采用酶联免疫吸附试验（enzyme-linked immuno-sorbent assay，ELISA）测定尿中阿司匹林代谢产物11dhTxB2的水平，阿司匹林低反应性，即阿司匹林作用下的血小板高反应性（high on aspirin platelet reactivity, HAPR）定义为11dhTxB2≥1 500 ng/g。根据检测结果将入选患者分为HAPR组和非血小板高反应性组（No-HAPR）。结果：2型糖尿病合并冠心病患者的基线尿11dhTxB2水平为(3 687±3 052) ng/g，服用阿司匹林治疗后尿11dhTxB2水平显著降低［(1 054±859) ng/g,P<0.001］;2型糖尿病合并冠心病患者中HAPR的发生率为32.5%，且HAPR组心血管事件的发生率明显高于No-HAPR组(P<0.05)。结论：尿11dhTxB2水平可作为评价2型糖尿病合并冠心病患者阿司匹林临床疗效的有效预测指标。
Objective：To elucidate the correlation between urinary 11-dehydro-thromboxane B2 (11dhTxB2) and clinical efficacy of aspirin treatment in patients with type 2 diabete and coronary artery disease (CAD). Methods:In this prospective cohort study, 169 aged patients with type 2 diabete accompanying CAD in Peking University First Hospital were enrolled. The level of urinary 11dhTxB2 was detected using enzyme-linked immuno-sorbent assay. Low aspirin response or high on aspirin platelet reactivity (HAPR) was defined as urinary 11dhTxB2>1 500 ng/g. All the included patients were divided into two groups based on the results, HAPR group and No-HAPR group. Results:Baseline urinary 11dhTxB2 of the patients with type 2 diabete accompanying CAD was (3 687±3 052) ng/g, while the urinary 11dhTxB2 was (1 954±859) ng/g in patients after 100 mg/d aspirin treatment (P<0.001). Prevalence of HAPR in patients with type 2 diabete accompanying CAD were 32.5%. Within a mean follow-up time of 12 months, the outcomes occurred more frequently in HAPR group than in NoHAPR group (P<0.05).Conclusion: Urinary 11dhTxB2 can be recognized as an effective indicator in evaluating aspirin clinical efficacy of patients with type 2 diabete accompanying CAD.