脑梗死后血小板CD62p表达的动态变化及抗血小板药物的影响

Serial changes of CD62p expression in platelet of patients after ischemic stroke and the influence of antiplatelet drugs

目的观察脑梗死急性期至恢复期CD62p的动态变化,并探讨抗血小板药物对其影响。方法选择急性脑梗死患者73例作为脑梗死组,并随机分为阿司匹林组(41例)和氯吡格雷组(32例)2个亚组分别进行治疗,同期选择年龄、性别相匹配的非脑血管病患者(高危对照组,20例)及健康体检者(健康对照组,20例),采用流式细胞技术,前2组于发病后<48 h、7、21、90天,另1组体检时对血小板CD62p表达进行检测,并作比较。结果与高危对照组及健康对照组比较,脑梗死组各时间点CD62p表达均显著增加(P<0.01);与<48 h比较,脑梗死组21天和90天时CD62p表达显著下降(P<0.01),但21天与90天比较差异无统计学意义(P>0.05)。90天时,氯吡格雷组CD62p表达显著低于阿司匹林组(P<0.05)。结论脑梗死急性期血小板活化增强,随时间延长,CD62p表达逐渐下降;氯吡格雷较阿司匹林具有更强的抑制CD62p表达作用。

Objective To observe the serial changes of CD62p from acute stage to recovery stage of cerebral infarction and to explore the effects of antiplatelet drugs on the expression of CD62p. Methods Platelet CD62p expression was examined serially using flow cytometry after acute cerebral infarction in 73 patients. The patients with cerebral infarction were randomly divided into 2 groups.aspirin group （41 cases）, treated with aspirin（0. 1 g/d） ~ clopidogrel group （32 cases）, treated with clopidogrel（75 mg/d）. The CD62p expression was also evaluated in 20 at-risk control subjects and 20 healthy volunteers. Results CD62p expression was significantly higher in the acute phase after cerebral infarction than in normal and at-risk control subjects （P 〈 0.01）. It decreased to a significantly lower level on day 21 ;and to a substantially lower level on day 90,but there was no significant difference between day 21and day 90 （P〉0.05）. CD62p expression was significantly suppressed by aspirin treatment and more substantially suppressed by clopidogrel on day 90 （P〈 0.05）. Conclusions Platelet activation was significantly increased in acute ischerflic stroke and gradually decreased thereafter. The lower long-term pharmacodynamic potency of aspirin relative to clopidogrel raises the prospect of the need for more effective antiplatelet agents or a synergistic combination therapy for stroke prevention in the future.