急性冠脉综合征患者介入治疗前后血小板活化标志物、聚集功能及凝血活性的变化

Changes of platelet activation markers and MAR in patients with acute coronary syndrome before and after PCI

目的:探讨血小板活化分子标志物P-选择素(CD62P)、血小板膜糖蛋白Ⅱb/Ⅲa(PAC-1)、血小板聚集率(MAR)、血浆纤维蛋白原(Fib)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)在急性冠脉综合征(ACS)患者介入治疗前后的变化。方法:采用流式细胞术检测ACS患者和冠状动脉造影结果正常者血清中CD62p及PAC-1水平,采用血小板聚集仪检测各组人群血小板聚集率(MAR)水平,应用凝血分析仪检测血浆Fib、PT、APTT及TT水平。观察各组患者经皮冠脉介入(PCI)术前后CD62p、PAC-1、MAR、Fib、PT、APTT及TT水平的变化。结果:ACS患者中,不稳定心绞痛(UAP)组及急性心肌梗死(AMI)组术后CD62p、PAC-1以及MAR水平较术前均明显升高(P<0.01),AMI组显著高于UAP组(P<0.05),UAP组和AMI组术后血浆Fib浓度较术前均显著升高(P<0.01),PT、APTT及TT的水平显著降低(P<0.01)。结论:ACS患者血小板活化程度及凝血活性水平升高可能是PCI术后血栓形成及支架内再狭窄的原因,检测ACS患者治疗前后CD62P、PAC-1、MAR、Fib、PT、APTT及TT水平对观察病情和预后判定具有重要意义。

Objective： To study the changes of plasma P-selectin （CD62P）, platelet membrane glycoprotein （PAC-1）, marximum platelet aggregation rate （MAR）, co ncentrat ion of plasma fibrinogen （Fib）, prothrombin time （PT）, activated partial thromboplastin time（APTr）, and thrombin time （TY） in patients with acute coronary syndrome （ACS） before and after PTCA. Methods： CD62P and PAC-1 from whole-blood samples in 85 patients with ACS before and after PCI were measured by FCM, MAR was measured by intelligent hemologic aggregation examiner, the concentration of Fib and the levels of PT, APTf, and TF were measured by hemostasis analyzer. The 85 pa- tients with ACS were 50 with unstable angina pectoris （UAP） and 35 with acute myocardial infarction （AMI）. Meanwhile age-sex matched 40 healthy persons were selected as controls. Results： There were significantly higher CD62p, PAC-1 and MAR level after PCI than those before PCI （P〈0.01） ,and there were significantly higher above-mentioned indexes in AMI group than those in UAP group（P〈0.05）; there were significantly higher Fib level and lower PT, APT＇F, and Tr level after PCI than those before PCI （P〈0.01）. Conclusion： De tection of the activation of platelet and blood clotting activity may play a important role in observation and prognostic judgment upon the status of patients with acute myocardial infarction.The result suggests that platelet activation is high in patients with ACS, platelet CD62P, PAC-1, MAR, PT, APTY, and 33＇ could be the effective index of monitoring coronary heart diseases.