普通肝素、达肝素及依诺肝素在冠状动脉造影术中对血小板激活的对比研究

The influence of unfractionated heparin,dalteparin and enoxaparin on platelet activation during coronary angiography

目的:了解普通肝素(UFH)、达肝素及依诺肝素对血小板激活的差别。方法:58例行冠状动脉造影术的心脏瓣膜病患者,分为UFH组、达肝素组和依诺肝素组。术前测体重,动脉穿刺成功后,按50U/kg经动脉鞘管内注射UFH(UFH组)、达肝素(达肝素组)或依诺肝素(依诺肝素组)。分别于给药前、给药后10min、20min取血,测定血小板活化标记物GPⅡb/Ⅲa、sCD40L、P-选择素(CD62P)及血友病因子(vWF)。结果:UFH组给药后10minGPⅡb/Ⅲa、血浆sCD40L及CD62P水平明显高于给药前(P<0.05),给药后20minGPⅡb/Ⅲa、sCD40L水平仍高于给药前(P<0.05),但CD62P水平与给药前差异无统计学意义(P>0.05);达肝素组和依诺肝素组给药后10min、20minGPⅡb/Ⅲa均明显高于给药前(P<0.05),但血浆sCD40L及CD62P水平变化差异无统计学意义(P>0.05);达肝素组给药后20min、依诺肝素组给药后10min血浆vWF较给药前显著降低(P<0.05)。结论:冠状动脉造影术中鞘内注射UFH、达肝素及依诺肝素均可激活血小板;与UFH相比,达肝素和依诺肝素对血小板的激活作用较小;而达肝素和依诺肝素对血小板的激活作用无明显差异。

Objective：To compare the difference in platelet activation among unfractionated heparin（UFH）,dalteparin and enoxaparin.Methods：Fifty-eight patients who were performed coronary angiography were enrolled in this study,and they were assigned to UFH group,dalteparin group or enoxaparin group.Before the operation,measuring the patients＇ body weight;after arterial puncture,injecting unfractionated heparin or LMWH （dalteparin or enoxaparin） through arterial sheath according to 50 U/Kg.Blood samples were obtained througharterial sheath so as to measure the plasma sCD40L,CD62P,vWF and platelet membrane GPⅡb/Ⅲa at pre-administration,10 minutes and 20 minutes after drug administration.Results：UFH group had higher expression of platelet membrane GPⅡb/Ⅲa and plasma CD62P levels compare to dalteparin group and enoxaparin group at 10 minutes after corresponding drug administration （P〈0.05）.At 20 minutes after drug administration no significant differences were found among the three groups with respect to the expression of platelet membrane GPⅡb/Ⅲa,plasma CD62P and sCD40L levels （all P〈0.05）.The vWF level in dalteparin group at 10 minutes of post-administration and enoxaparin group at 20 minutes of post-administration were significantly lower than pre-administration （P〈0.05）.Conclusion：Intrathecal injection of unfractionated heparin,dalteparin and enoxaparin in coronary angiography all can activate platelet.Compare to UFH,dalteparin and enoxaparin have less effect on platelet activation.There were not significant differences between the effect of dalteparin and enoxaparin on platelet activation.