急性冠脉综合征患者PAC-1的变化及氯吡格雷干预后的临床研究

Effects of clopidogrel on the pletelet activitored combined-1 in patients with acute coronary syndrom undergoing therapy

目的:对急性冠脉综合征(ACS)患者用药前后血小板激活复合物-1(PAC-1)及血浆组织纤溶酶原激活物抑制剂-1(PAI-1)、血浆组织纤溶酶原激活物(T-PA)的检测,判断PAC-1是否可作为ACS病情监测的有效指标。方法:选取2008年1月至2008年12月入院治疗的ACS患者共60例,根据不稳定性心绞痛(UAP)和急性心肌梗死(AMI)的诊断标准设立为UAP组30例,AMI组30例,并设立对照组30例,分别测定PAC-1表达率、PAI-1与T-PA的含量测定,比较3组间PAC-1、PAI-1与T-PA含量的差异,同时在ACS患者给予常规药物治疗的基础上,观察患者治疗前及治疗后的取血时间点PAC-1、PAI-1与T-PA含量的变化,比较PAC-1、PAI-1与T-PA的变化情况。结果:①治疗前,ACS患者PAC-1的表达率及PAI-1含量、T-PA含量均高于对照组(P<0.01),其中AMI组PAI-1及PAC-1的表达率水平明显高于UAP组(P<0.05),而T-PA差异无统计学意义(P<0.05);②治疗后UAP氯吡格雷常规剂量组及常规治疗组各指标仍高于对照组(P<0.05);两亚组治疗后与治疗前比较,血PAC-1表达率、PAI-1含量有显著性降低,T-PA含量显著性升高(P<0.05);治疗后两亚组组间比较,氯吡格雷常规剂量组血PAC-1表达率、PAI-1含量降低更显著,T-PA含量显著性升高,组间有显著差异(P<0.05);③AMI三联组患者治疗后与治疗前比较血PAC-1表达率、PAI-1含量均显著性降低,T-PA含量显著性升高(P<0.05);④ACS患者治疗后各指标仍高于对照组,有显著性差异(P<0.05)。结论:①血小板膜糖蛋白Ⅱb/Ⅲa复合物纤维蛋白原受体PAC-1可作为冠心病患者病情检测的灵敏指标;②T-PA/PAI-1可作为反映冠心病患者内源性纤溶系统活性的有效指标;③氯吡格雷起效迅速,对急性冠脉综合征患者可显著抑制血小板活化,降低纤溶抑制系统活性。

Objective ： To compare the effectiveness of different dosage and administration ways on the platelet func- tion （ PAC - 1 ） and fibrinoiytie system （PAI - 1, T - PA） of patients with ACS. Methods： From January 2008 to December 2008 ;60 patients with ACS are enrolled in this study. All patients are given the drugs of regular and are divided into 3 groups depending on the different dosage and administration ways, plasma PAC - 1, PAI - 1, T - PA content were measured at pre - treatment and post - treatment. Results： （1）In ACS at pre - treatment, the level of PAC -1, PAI -1 ,T- PA are higher than that of health control group（P 〈0. 01 ） , and the changes of these mark- ers are more significantly in AMI patients than UAP patients （P 〈 0.05 ） ; （2）Afier the therapy, in the elopidogrel rou- tine dosage group and aspirin group, PAC - 1, PAI- 1 are lower than that of blank control group （ P 〈 0. 05 ） and T -PA is highter（P 〈 0.05 ） ; After the therapy, in routine dosage group and aspirin group, PAC - 1, PAI- 1 are lower than pre - treatment（ P 〈 0. 05 ） and T - PA is bighter（ P 〈 0. 05 ） ; After the therapy, in the elopidogrel rou- tine dosage group, PAC - 1, PAl - 1 are much lower than that of aspirin group and T - PA is much highter （ P 〈 0. 05） ; （3）After the therapy, in AMI combination group, PAC - 1, PAl - 1 are lower than pre - treatment （ P 〈 0. 05 ） and T- PA is highter（P 〈 0. 05 ） ;（4）In ACS at post- treatment, the changes of these markers are more sig- nificantly than control group （ P 〈 O. 05 ）. Conclusion： （1）PAC - 1 is the one of sensitive markers representing the severity of coronary heart diseases; （2）T - PA/PAI - 1 are the sensitive markers of fibrinolytic system in ACS;（3） The long - time use of routine dosage clopidogrel may improve the activity of fibrinolytic system of ACS patients.