不稳定型心绞痛介入治疗前后vWF和GMP-140的变化及临床意义

Clinical evaluation of changes of vWF and GMP-140 in unstable angina pectoris cases after percutaneous coronary intervention

目的探讨不稳定型心绞痛(UAP)患者经皮冠状动脉介入治疗(PCI)后假性血友病因子(vWF)和血小板α颗粒蛋白(GMP-140)水平的变化规律及临床意义。方法连续观察35例(A组)UAP患者PCI术前及术后1、24、72 h血液中vWF和GMP-140的变化。另设单纯行冠脉造影的UAP患者30例(B组)和健康者30例(C组)作对照。vWF和GMP-140分别用酶联免疫吸附双抗体夹心法测定血浆含量,并随访术后3个月心血管事件的发生情况。结果vWF在A、B组的浓度显著高于C组(P<0.01),A组介入治疗后1 h进一步升高,持续至24 h(P<0.05),然后逐渐回落;B组术前与术后无显著改变。A、B组GMP-140的浓度显著高于C组(P<0.05),A组介入治疗后在1 h即达峰值(P<0.01),然后迅速回落,72 h至术前水平;随访期内B组心血管事件发生率显著高于A组(57%vs14%,P<0.01)。结论UAP患者介入治疗后vWF、GMP-140在72 h内有动态变化,反映了PCI后冠脉内皮功能受损和血小板激活上述指标持续升高,可能是术后早期心血管事件的危险因素。

AIM To evaluate the changes and significances of von Willebrand Factor （vWF） and alphaGranule Membrance Protein -140 （GMP-140）in unstable angina pectoris patients after percutaneous coronary intervention（PCI）. METHODS The changes of vWF and GMP-140 were tested before and 1,24 and 72 h after PCI in 35 unstable angina pectoris patients （ A group）, 30 UAP patients （ B group） who had undertaken coronary angiography and 30 normal subjects （C group）. All the UAP patients were followed up for 3 months. RESULTS The concentrations of vWF and GMP-140 in UAP cases significantly increased compared with those in normal subjects（P 〈0.01, P 〈0.05 ） . The level of vWF reached its peak 24.h after PCI （ P 〈 0.05 ） and the level of GMP-140 raised 1 h after PCI（ P 〈 0.01 ） and dropped to that before PCI at 24 h ～ 72 h . The morbidity of vascular disease in group B was higher than that of group A after PCI （57% vs 14% ,P 〈0.01 ）. CONCLUSION The plasma level of vWF and GMP-140 in UAP patients changes significantly after PCI. The damage of endothelium of coronary artery and the activation of platelets. The higher level of them in PCI 72 h might be responsible for the early clinical events.