联用阿司匹林氯吡格雷对不稳定型心绞痛病人血小板功能的影响

EFFECTS OF ASPIRIN ADDING CLOPIDOGREL ON PLATELET FUNCTION IN PATIENTS WITH UNSTABLE ANGINA PECTORIS

目的:以血小板功能变化为指标,评价联用阿司匹林氯吡格雷在不稳定型心绞痛(UAP)病人中的应用价值。方法:选择52例我院住院UAP病人,随机分为联用阿司匹林氯吡格雷组(25例),阿司匹林100mg/d加氯吡格雷75mg/d;单用阿司匹林组(27例),阿司匹林100mg/d。分别于入院时、入院治疗7d后抽取肘静脉血,测定血浆GMP-140浓度及血小板聚集率,观察其治疗前后及在不同治疗组的变化。另选年龄性别都与UAP病人相当的健康者20例作为正常对照组。结果:UAP病人血浆GMP-140及血小板聚集率较正常组明显升高(P<0.01),且两组间无显著差异;经治疗7d后血浆GMP-140及血小板聚集率明显下降(P<0.01),联合用药组血浆GMP-140与血小板聚集率明显低于阿司匹林组(P<0.01);联合用药组治疗后血浆GMP-140浓度仍显著高于正常对照组(P<0.01),血小板聚集率也显著高于正常对照组(P<0.05)。结论:UAP病人存在血小板活化高聚集状态,目前对于UAP病人的标准治疗可显著抑制血小板活化聚集功能,联用阿司匹林和氯吡格雷在抗血小板活化聚集功能上有显著的疗效,明显优于单用阿司匹林。经双联治疗7d,UAP病人血小板活化聚集功能虽明显减弱,但仍未恢复正常。

Objective：To observe the effects of aspirin adding clopidogrel on platelet function in patients with unstable angina pectoris（UAP） and to discuss its clinical value. Methods： 52 UAP patients were randomly divided into two groups： aspirin adding clopidogrel group （n = 25 ）, aspirin 100mg/d, adding clopidogrel 75mg/d. Aspirin group（ n = 27） , aspirin 100mg/d. In addition ,20 healthy subjects were chosen as healthy control group. Blood samples were obtained for the detection of plasma GMP - 140 and platelet aggregation rate induced by ADP, when the patients were admitted after 7 days. Results：The level of plasma GMP -140 and platelet aggregation rate in UAP patients were obviously higher than that in healthy subjects （ P 〈 0. 01 ） and there was no significant difference between two groups. After 7 days treatment, the level of plasma GMP - 140 and platelet aggregation rate descended obviously in two groups （ P 〈 0. 01 ） and they were more lower in aspirin adding clopidogel group（P 〈0. 01 ）. But the level of plasma GMP - 140 in aspirin adding clopidogrel group after 7days treatment is still higher than that in healthy subjects（ P 〈 0. 01 ）. The level of platelet aggregation rate in aspirin adding clopidogrel group after 7days treatment is also higher than that in healthy subjects （P 〈 0. 05 ）. Conclusion：Platelet activation and aggregation play an important role in the development of UAP and they will be inhibited obviously after standard therapy. The anti - platelet aggregation and anti - platelet activation of aspirin adding clopidogrel is more effective than that of single aspirin. How- ever, even if in aspirin adding clopidogrel group, the platelet function of activation and aggregation is still abnormal after 7 days treatment.