抗血小板聚集药物对急性冠脉综合征患者血清sCD40L及磷脂酶A2的影响

Effect of anti-platelet aggregration drugs on sCD40L and phospholipase A2 in patients with acute coronary syndrome

目的探讨不同抗血小板聚集药物对急性冠脉综合征患者血清sCD40L和磷脂酶A2(phospholipase A2,PLA2)的影响。方法选择2010年2月至2011年5月在粤北人民医院住院,诊断为急性冠脉综合征的患者80例为研究对象,其中稳定型心绞痛20例设为A组,不稳定型心绞痛40例设为A+C组,急性心肌梗死20例设为A+H+C组。A组20例在标准药物治疗方案基础上采用阿司匹林治疗,A+C组40例在上述标准治疗基础上采用阿司匹林加氯吡格雷治疗,A+H+C组20例在上述标准治疗基础上采用阿司匹林加低分子肝素加氯吡格雷治疗。另外,选择20例经冠状动脉造影检查无冠状动脉病变的患者作为正常对照组。检测并比较分析治疗前和治疗后不同时刻各组血清sCD40L、PLA2浓度。结果 A组的血清sCD40L和PLA2与对照组比较,差异无统计学意义(P>0.05),但在A+C组和A+H+C组中,这两种炎症因子显著升高,与正常组和A组比较,差异有统计学意义(P<0.01)。A+H+C组及A+C组治疗后各时间点血清sCD40L、PLA2浓度均比治疗前降低,差异有统计学意义(P<0.01),且A+H+C组下降更明显。结论 sCD40L和PLA2是急性冠脉综合征的炎症因子;对急性冠脉综合征患者早期强化抗凝治疗可以获得积极治疗效果。

Objectives To approach the effect of different anti-platelet aggregration drugs on sCD40L and phospholipase A2 （PLA2） in patients with acute coronary syndrome （ACS）. Methods Eighty patients with ACS in Yue Bei People＇s Hospital were selected as subjects, among whom 20 were stable angina patients （A group）, 40 were unstable angina pectoris patients （A＋C group） and 20 were acute myocardial infarction patients （A＋H＋C goup）. The 20 patients in A group received acenterine, 40 patients in A＋C group received acenterine plus clopidogrel, 20 patients in A＋H＋C group received acenterine plus clopidogrel plus low molecular heparin respectively. Meanwhile, 20 patients without coronary artery damage were selected as control group. Secrum concentrations of sCD40L and PLA2 before and after treatment were measured and compared. Results There were no significant differences of secrum concentrations of sCD40L and PLA2 between control group and A group （P〉0.05）, but they were significantly higher in A＋C group and A＋H ＋C goup when compared to those of control group and A group （P〈0.01）. Secrum concentrations of sCD40L and PLA2 at all time point after treatment in A＋H＋C group and A＋C group were significantly lower than those before treatment （P〈 0.01 ）, expercial in A＋H＋C group. Conclusions sCD40L and PLA2 are the inflammatory factors of ACS. Patients with ACS may be obtained the best curative effect by using intensive anticoagulation at early stage.