【摘要】目的 研究T2DM合并冠心病老年患者对阿司匹林的反应性及其危险因素。 方法 选择老年科住院的T2DM合并冠心病患者147例，根据血栓弹力图(TEG)结果将其分为阿司匹林抵抗组(AR，抑制率≤50%)和阿司匹林非抵抗组(NAR)，并分析两组临床数据。结果 AR组30例，NAR组117例。AR发生率为20%。AR组同型半胱氨酸(Hcy)、FPG、TG、LDL-C及HbA1c分别为(16.43±4.77)mmol/L，(7.73±0.16)mmol/L，(1.70±0.60)mmol/L，(2.60±0.55)mmol/L，(7.79±0.58)%，均明显高于NAR组，而视黄醇结合蛋白(RBP)为(34.17±9.30)mmol/L，低于NAR组(P<0.05)。Logistic回归分析结果显示，FPG、TC、LDL-C和Hcy是AR的影响因素，是患者AR的危险性分别提高1.9倍，0.1倍，13.1倍和1.1倍。血糖不达标者、糖尿病病程较长者AR发生率增高(P<0.05)。结论 T2DM合并冠心病患者存在一定的AR现象，有效地控制血糖，减低血脂，降低Hcy，可降低AR发生率。

　　【关键词】 糖尿病，2型;冠心病;阿司匹林抵抗

　　【Abstract】Objective To study the reactivity and the risk factors of aspirin in the elderly patients of type 2 diabetes with coronary heart disease. Methods The 147 elderly hospitalized patients of type 2 diabetes with coronary heart disease were devided into AR group (inhibitory rate ≤ 50%) and NAR group according to thrombelastograph (TEG) results and the clinical data of two groups were analyzed. AlphaResults There were 30 patients in AR group and 117 patients in NAR group. The incidence rate of aspirin resistance was 20%. The homocysteine level (Hcy), FPG, TG, LDL-C and HbA1c were higher in AR group than in NAR group[(16.43 ± 4.77) mmol/L, (7.73 ± 0.16) mmol/L, (1.70 ± 0.60) mmol/L, (2.60 ± 0.55) mmol/L, (7.79±0.58) %, respectively],but retinol binding protein (RBP) was lower in AR group than in NAR group (P < 0.05) . Logistic regression analysis results showed that FPG, TG, LDL-C and Hcy were the impact factors of aspirin resistance, and made the risk of aspirin resistance of patients enhanced by 1.9 times ,0,1 times,13.1 times ,1.1 times, respectively..The incidence rate of aspirin resistance was increased in patients with pathoglycemia and longer course of diabetes (P < 0.05). Conclusion There exists certain aspirin resistance in elderly patients of type 2 diabetes with coronary heart disease, if blood glucose was effectively controlled, blood lipid and Hcy were reduced effectively, the incidence of aspirin resistance would be decreased.

　　【Key words】Diabetes mellitus，type 2;Coronary heart disease, Aspirin resistance