颈动脉支架置入术后循环血小板活化和聚集的系列变化

Serial Changes in Circulating Platelet Activation and Platelet Aggregation After Carotid Artery Stenting

目的观察颈动脉支架置入术（CAS）后1周内血小板活化指标和聚集功能的系列变化。方法20例症状性颈动脉狭窄患者,在CAS术前即刻、术后0.5 h、18 h和6 d的外周血中,分别检测血小板-单核细胞聚集体和纤维蛋白原受体（流式细胞术）、血小板聚集功能（比浊法）、血清可溶性CD 40配体与可溶性P-选择素（酶联免疫吸附法）的变化。患者均于术前应用了阿司匹林和氯吡格雷的双抗血小板治疗,并于术中应用了栓子保护装置。结果可溶性CD 40配体于术后18 h、6 d与术前即刻比较均有升高,分别2.35（1.14~5.38）ng/ml、4.10（2.27~6.91）ng/ml vs 0.8（0.23~2.38）ng/ml,P〈0.05。可溶性P-选择素于术后6 d与术前即刻比较也有升高（73.03±35.4 ng/ml vs 54.46±28.53 ng/ml,P〈0.05）。而单核细胞-血小板聚集体、纤维蛋白原受体和血小板聚集于术后没有变化。结论尽管在术前给予双抗血小板药物并术中应用栓子保护装置,血清可溶性CD 40配体与可溶性P-选择素的升高提示CAS后仍存在血小板激活。

Objective We investigated serial changes of circulation platelet activation markers in vivo and platelet aggregation function in vitro in patients undergoing carotid artery stenting（CAS） within 1 week. Methods The platelet-monoeyte aggregates and fibrinogen reeeptors analyzed by flow eytometrie and platelet aggregation tests using Born＇s method as well as serum soluble CD 40 ligand and soluble P-seleetin quantified by enzyme-linked immunosorbent assay were determined in twenty patients with symptomatic carotid stenosis undergoing CAS. Blood samples were obtained immediately before stent implantation and O. 5 h, 18 h,6 d after the procedure respectively. All twenty patients were on dual antiplatelet therapy of aspirin and elopidogrel before CAS, and all patients were stented with embolie protection devices. Results Soluble CD 40 ligand levels increased from O. 8 （0.23 - 2.38 ） ng/ml before procedure to 2.35 （ 1.14 - 5.38 ） ng/ml,4. 10 （2.27 6.91 ）ng/ml at 18 h and 6 d after the procedure respectively （P 〈0.05 ）. Similary, soluble P-selectin levels increased from 54.46 ± 28.53 ng/ml before procedure to 73.03 ± 35.4 ng/ml at 6 d after the procedure （ P 〈 0. 05 ）. Circulation plateletmonocyte aggregates, fibrinogen receptors and the maximum platelet aggregation rate, however, were not changed after the procedure. Conclusion Elevated serum soluble CD 40 ligand and soluble P-selectin levels indieate the oeeurrence of platelet aetivation after CAS, despite treatment with dual antiplatelet therapy before CAS and the application of embolie protection devices during the procedure.