不稳定型心绞痛合并抑郁症患者血小板活化及舍曲林治疗研究

The Clinical Study on Platelet Activation in Unstable Angina Patients with Depression

目的:比较不稳定型心绞痛病人与同时合并抑郁症的不稳定型心绞痛病人的血小板活化状态,以及后者在舍曲林(血清素再摄取抑制剂)治疗前后血小板活化状态的改变,以β-血栓球蛋白(β-TG)血浆浓度作为血小板活化的血浆标志物。方法:不稳定型心绞痛病人(UA组)78例被分为两组:A组40例确诊为不稳定型心绞痛不伴抑郁症;B组为38例,确诊为不稳定型心绞痛伴抑郁症(其中B组随机分为B1,B2两组,各为19例,分别给予标准药物治疗及联合舍曲林药物治疗)。以42例健康人为对照,以β-TG作为血小板活化功能检测的标志物,分别在治疗前测量(A组,B组)以及治疗4周后测量(B组)β-TG浓度。结果:血浆β-TG浓度A组(16.4±3.2 IU/ml)和B组(治疗前为19.8±2.7 IU/ml)比健康组(10.4±2.7 IU/ml)明显升高,具有统计学意义(p<0.05),并且不稳定型心绞痛合并抑郁症组病人β-TG浓度值较单纯不稳定型心绞痛病组升高,差异有统计学意义P<0.01);舍曲林治疗前后β-血栓球蛋白(β-TG)血浆浓度变化(治疗后为21.6±3.3 IU/ml)具有统计学意义(p<0.05)。结论:不稳定型心绞痛合并抑郁症组病人中,血小板的活化程度高于单纯不稳定型心绞痛病人,且舍曲林治疗可减轻血小板活化程度。

Objective： To compare the state of PLT activation in unstable angina patients with and without depression. To assess plasma concentration of β-TG in unstable angina patients with depression before and during treatment with the selective serotonin reuptake inhibitor（SSRIs） sertraline. The assessment of PLT activation was based on the concentration of β- TG as serum markers of the activation. Methods ：The study group consisted of 78 patients with unstable angina who were divided into two groups： Group A ：40 patients without depression. , and group B ：38 patients with depression. An immunoenzymatic method （ELISA, Stago Diagnostic ） was used to measure the β- thromboglobulin blood plasma concentration. β - TG was measured at baseline （ groups A and B ） and after 4 weeks of standard medical therapy and treatment with sertraline for unstable angina （group B）. The control group consisted of 42 healthy subjects. Results：The mean β-TG concentration in group A （ 16.4 ±3.2IU/ml） and B （ 19.8±2.7 IU/ml - before） was significantly { p 〈 0.05） higher than in controls （10.4 ± 2.7 IU/ml）. The concentration of β-TG was statistically significantly higher （ p 〈 0.05 ） in unstable angina with depression as compared to those with no depressive disorders. In patients with depression, the concentration of β-TG were affected by treatment with sertraline （ 21.6±3.3IU/ml - after treatment , p 〈 0.05 ）. Conclusion ： Concentrations of β- TG are increased in patients with unstable angina due to platelet activation. Unstable angina patients suffering from depression show enhanced intravascular platelet activation. Treatment with sertraline in depressed unstable angina patients is associated with reductions in platelet activation