冠状动脉支架术对冠心病患者血小板活化功能的影响

Coronary Stenting Impact Platelet Activation in Patients with Coronary Artery Disease

目的探讨冠心病患者行冠状动脉内支架置入术前后血小板活化指标的变化,了解冠心病不同临床类型支架置入数与血小板活化指标之间的关系。方法利用流式细胞术和单克隆抗体测定48例稳定型心绞痛、45例不稳定型心绞痛患者与37例急性心肌梗死患者外周血中血小板膜糖蛋白CD62p、CD63和凝血酶敏感蛋白的阳性表达率,并与45例冠状动脉造影正常者作对照分析。结果稳定型心绞痛患者、不稳定型心绞痛患者和急性心肌梗死患者支架置入后CD62p、CD63和凝血酶敏感蛋白的阳性表达率均显著高于支架置入前(P<0.01);不稳定型心绞痛组和急性心肌梗死组治疗前亦高于对照组(P<0.01),而稳定型心绞痛组治疗前与对照组比较差异无显著性(P>0.05)。稳定型心绞痛组和不稳定型心绞痛组CD62p、CD63和凝血酶敏感蛋白的阳性表达率与支架置入个数有关,置入支架越多阳性表达率越高。结论不稳定型心绞痛患者及急性心肌梗死患者存在血小板高活化状态、动脉粥样硬化斑块破裂以及急性血栓形成。支架置入术对冠状动脉内皮的损伤加强了血小板的活化,增加了血栓形成的风险。

Aim To approach the change of platelet activation before and after stenting for coronary artery disease and the relationship among stable angina pectoris { SAP）, unstable angina pectoris {UAP）, acute myocsrdial infarction（ AMI）, number of stent hnplantation and platelet activation. Methods Detection of positive expression of platelet membrane glycoprotein CD62p, CD63 and thrombin-sensifive protein{TSP） was performed by flow cytometry and monoclonal antibody in 175 patients. They were divided into four groups： SAP group （48 patients with stable angina）;; UAP group （45 patients with unstable angina）; AMI group （37 patients with acute myocardial infarction） and control group （45 patients with angiography）. Results There were increased the levels of CD62p, CD63 and thrombin-sensitive protein expression after stent implantation in coronary artery disease （ P 〈 0.01 ）, and the expression levels of UAP group and AMI group were higher than that of control group （ P 〈 0.01 ）. The positive expression of CD62p, CD63 and thrombin-sensitive protein were related to number of stenting. The more stenting, the higher positive expression. Conclusion Unstable angina and acute myocardial infarction presented high level of platelet activation, atherosclerosis plaque rapture and prone to thrombosis. Stenting induced endothelial damage sugmented platelet activation and increased the risk of thrombosis.