目的：探討氯吡格雷用于冠心病合并糖尿病患者行冠脈介入治療后對YKL-40、NF-κB的影響。方法 選擇2013年8月-2016年12月在西寧市第一人民醫(yī)院進(jìn)行經(jīng)皮冠脈介入治療手術(shù)的冠心病合并糖尿病患者80例，隨機(jī)分為兩組，每組40例，對照組患者圍術(shù)期接受阿司匹林治療，觀察組患者在對照組基礎(chǔ)上接受氯吡格雷治療，服用3~5 d后進(jìn)行經(jīng)皮冠脈介入治療，術(shù)后持續(xù)治療1個月后評價療效。比較兩組患者治療7 d后的血小板聚集情況；治療1個月后評價兩組患者治療后的臨床療效，分別檢測并分析兩組患者治療前后的幾丁質(zhì)酶-3樣蛋白-1（YKL-40）以及轉(zhuǎn)錄因子-κB（NF-κB）含量水平，記錄并分析兩組患者圍術(shù)期不良反應(yīng)事件的發(fā)生情況。結(jié)果 手術(shù)7 d后，觀察組的血小板聚集率顯著低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療1個月后，觀察組的臨床療效顯著高于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。兩組患者經(jīng)過治療后，YKL-40以及NF-κB較治療前均顯著降低，差異有統(tǒng)計學(xué)意義（P<0.05）；且觀察組顯著低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。兩組患者發(fā)生血小板減少、消化道出血等不良事件發(fā)生率的差異無統(tǒng)計學(xué)意義；觀察組發(fā)生心肌梗死、心絞痛、死亡等心血管不良事件的發(fā)生率雖然低于對照組，但是差異無統(tǒng)計學(xué)意義；觀察組患者不良反應(yīng)的總發(fā)生率顯著低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 氯吡格雷聯(lián)合阿司匹林用于冠心病合并糖尿病患者圍術(shù)期的抗血小板治療，臨床療效較好，可有效控制患者體內(nèi)炎癥反應(yīng)，降低不良事件的發(fā)生率，安全性較好，值得臨床推廣應(yīng)用。

Objective To explore the effect of clopidogrel on the YKL-40 and NF-κB levels in patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus. Methods Totally 80 patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus were collected in our hospital from August 2013 to December 2016, and divided into two groups randomly, control group (n=40) were adopted aspirin treatment during perioperative period, study group (n=40) were adopted clopidogrel based on the treatment of control group. The platelet aggregation of two groups were compared after treatment, and the curative effect was evaluated and analyzed; The level of chitinase-3 like protein -1 (YKL-40) and nuclear factor κB (NF-κB) were detected before and after treatment; The adverse reactions of patients in two groups during perioperative period were recorded and analyzed. Results After 7 d treatment, the platelet aggregation rate of study group were significantly lower than those patients in control group (P<0.05). The total effective rate of study group was significantly higher than that of control group (P<0.05). After treatment, the YKL-40 and NF-κB levels of all patients decreased significantly compared with pre-treatment (P<0.05), and the content was lower than that in control group (P<0.05); The difference of thrombocytopenia and gastrointestinal bleeding incidence between two groups has no significance. Although the incidences of myocardial infarction, angina pectoris and death were lower than those in control group, the difference between two groups has no significance. The total incidence of adverse reactions of patients in study group was lower significantly than that in control group (P<0.05). Conclusion Clopidogrel combined with aspirin for antiplatelet therapy in patients undergoing percutaneous coronary intervention with coronary heart disease with diabetes mellitus deserves popularization in clinical, which not only possesses well clinical curative effect and safety, but controls the inflammatory response and decreases adverse reactions.