肺源性心脏病患者血小板活化及对策

Platelet Activation and the Management in the Patients with Cor Pulmonale

目的 :探讨肺心病与血小板活化之间的关系及其对策。方法 :采用双抗体夹心固相酶免疫试验法和放射免疫法分别测定了 193例慢性肺源性心脏病患者和 170例健康人血浆GMP - 140、TXB2 、vWF、6 -keto -PGF1α浓度及TXB2 / 6 -keto -PGF1α比值 ,同时对抗血小板治疗组与非治疗组进行了比较。结果 :肺心病各期、各组患者血浆GMP - 140、TXB2 、vWF及TXB2 / 6 -keto-PGF1α比值均高于对照组 ,急性发作期高于缓解期 (P <0 .0 1) ;抗血小板治疗组则低于非治疗组 (P <0 .0 1) ;而血浆 6 -keto -PGF1α浓度 ,肺心病各期各组低于对照组 ,急性发作期低于缓解期 (P <0 .0 1) ;抗血小板治疗组则高于非治疗组 (P <0 .0 1)。结论 :⑴肺心病患者体内血小板高度活化 ,以急性发作期尤为显著 ,对肺心病的发生、发展及转归起一定作用。⑵血浆vWF浓度变化与GMP - 140基本相仿 ,也可作为血小板活化的指标之一。⑶抗血小板治疗可以作为肺心病的治疗方法之一 ,以改善肺循环功能 ,促进肺心病急性发作的缓解。

Objective: To study the state of platelet activation and management in patients with cor pulmonale. Methods:The serum level of GMP-140, TXB 2, vWF and 6-keto-PGF 1α were measured in 193 cor pulmonale patients and 170 normal persons. Results:1. The level of GMP-140, TXB 2, vWF and TXB 2/6-keto-PGF 1α were significantly higher in different groups and phases of cor pulmonale than the normal control ( P <0.01). The levels of 6-keto-PGF 1α were significantly lower than control group ( P <0.01). 2. The level of GMP-140, TXB 2, vWF and TXB 2/6-keto-PGF 1α were significantly higher in acute phase of cor pulmonale than chronic phase ( P <0.01). The level of 6-keto-PGF 1α were significantly lower ( P <0.01). 3. The level of GMP-140, TXB 2, vWF and TXB 2/6-keto-PGF 1α were significantly higher in cor pulmonale with non anti-platelet therapy than anti-platelet ( P <0.01). The levels of 6-keto-PGF 1α were significantly lower ( P <0.01). Conclusions:1.Platelet is markedly activated in cor pulmonale patients, especially in acute phase. 2.Platelet activation may play an important role in the pathogenesis and progression of cor pulmonale. 3.Anti-platelet therapy can reduce platelet activation. It may be advantageous for the patients with cor pulmonale.