冠心病患者抗血小板治疗短期内血小板多项参数的变化趋势

Short-term changes of the platelet parameters after antiplatelet therapy in patients with coronary heart disease

目的:观察不同类型冠心病患者血小板活化、血小板聚集率,比较各组间差异及同组患者治疗前后血小板各项指标的变化。方法收集我院心内科2011年3月至2012年2月期间108例冠心病患者:分为稳定型心绞痛、不稳定型心绞痛、急性心肌梗死3组。入院时均查血小板活化指标PAC-1、CD62p和血小板聚集率(分别由AA或ADP诱导的),比较各组间上述指标的差异。按病情给予抗血小板治疗、PCI治疗及其他常规治疗,治疗10d后重复检查上述指标,比较治疗前后上述各项指标变化及治疗后各组患者与正常对照组间的差异程度。结果:入院时冠心病各组的PAC-1、CD62p阳性率、血小板聚集率水平均较对照组高(P<0.05),而AMI组最为显著。治疗10d后各组CHD患者上述指标均较入院时明显降低(P<0.01)。治疗后,除SAP组患者CD62p对比对照组无明显差异,其余各组CD62p及各组PAC-1仍高于对照组(P<0.05)。结论:PAC-1、CD62p、血小板聚集率可作为早期发现冠心病、观察病情变化、实现个体化治疗的重要方法。

Objective To observe the platelet activation and platelet aggregation of patients with different types of coronary heart disease, and to compare these indexes of patients in different groups and of patients before and after treatment. Methods 108 patients with coronary heart disease in our hospital from Mar 2011 to Feb 2012 were selected, and were divided into stable angina pectoris group （SAP group）, unstable angina group （UA group）, and acute myocardial infarction group （AMI group）. Normal controls （NC group） were selected at the same time. Platelet activation index （PAC-1, CD62p）, arachidonic acid （AA） and adenosine diphosphate （ADP）-induced platelet aggregation were measured at the admission. According to the status of patients, antiplatelet therapy, PCI and other conventional treatment were administered. The changes of these indexes before and after the treatment, and the differences among the four groups were analyzed. Results At the admission, PAC- 1, CD62p and platelet aggregation rate in SAP group, UA group and AMI group were all higher than those in NC group （P 〈 0.05）, and were decreased after 10 days of therapy （P 〈 0.0!）. After treatments, CD62p in UA group and AMI group were higher than that in NC group. PAC-1 in SAP group, UA group and AMI group were higher than that in NC group （P 〈 0.05）. Conclusion PAC-1, CD62p and platelet aggregation rate were important for detecting coronary heart disease early, for observing patients＇ condition changes, and for implementing individualized therapy.