不同剂量氯吡格雷对冠状动脉粥样硬化性心脏病患者血清CD62p水平的影响

Effects of different dose of clopidogrel on serum CD62p level in patients with coronary heart disease

目的 观察不同剂量氯吡格雷对冠状动脉粥样硬化性心脏病（冠心病）患者血清CD62p水平的影响.方法 选择观察对象191例,其中稳定型心绞痛（SAP）患者95例,非ST段抬高型急性冠状动脉综合征（NST-ACS）患者66例,SAP患者随机分为A组（48例）、B组（47例）,NST-ACS患者随机分成C组（33例）、D组（33例）,健康对照人群30名为E组.A组确诊后给予氯吡格雷75 mg/d,B组确诊后给予氯吡格雷150 mg/d;C组确诊后立即给予负荷剂量氯吡格雷300 mg,后予维持量75 mg/d,D组确诊后立即给予负荷剂量氯吡格雷300 mg,后予维持量150 mg/d.分别于服药前、服用负荷剂量氯吡格雷24h、服用氯吡格雷第5天抽取外周静脉血,应用酶联免疫吸附试验法测定血清CD62p的浓度.结果 （1）服药前血清CD62p的浓度：SAP患者[A组（7.62±2.99） ng/L、B组（8.48±3.13） ng/L]和NST-ACS患者[C组（9.50±3.32） ng/L、D组（10.22±5.14） ng/L]均高于健康对照者[（E组（5.49±1.99）ng/L,P均＜0.01],且NST-ACS患者高于SAP组患者（P＜0.05）.（2）SAP患者服药后第5天血清CD62p浓度[（A组（6.79±2.51） ng/L、B组（6.37±1.80） ng/L]均较服药前[A组（7.62±2.99） ng/L、B组（8.48±3.13） ng/L]降低（t=2.390、t=4.520,P＜0.05和P＜0.01）,且两组患者服药后血清CD62p浓度相比较差异无统计学意义（P均＞0.05）.（3）C、D两组患者服药后第5天血清CD62p浓度[C组（8.21±2.62） ng/L、D组（8.17±2.37） ng/L均明显低于服药前[C组（9.50±3.32） ng/L、D组（10.22±5.14） ng/L],差异有统计学意义（t值分别为2.084、2.157,P均＜0.05）,且两组患者服药后血清CD62p浓度比较差异无统计学意义（P＞0.05）.结论 冠心病患者血清CD62p水平高于健康人群,服用氯吡格雷可降低冠心病患者的血清CD62p水平.

Objective To investigate the change of serum CD62p of coronary heart disease （CHD） patients after different doses of clopidogrel administration.Methods One hundred and ninety-one patients with CHD were selected as our subjects.Of which,95 cases were with SAP and 66 cases were with non ST segment elevation acute coronary syndrome （NST-ACS）.SAP patients were randomly given clopidogrel at dose of 75 mg/d or 150 mg/d and served as A and B groups.NST-ACS patients were randomly given 300 mg clopidogrel,then randomly divided into C and D groups with sequentially taking clopidogrel at dose of 75 mg/d or 150 mg/d respectively.Thirty healthy peoples were served as E group without drug intervention.Concentrations of serum CD62p were detected by Elisa before taking clopidogrel,24 h and the fifty day of after taking clopidogrel.Results （1） Before taking clopidogrel,the serum concentrations of CD62p in CHD patients were higher （A group：（7.62 ± 2.99） ng/L,B group：（8.48 ± 3.13） ng/L,C group：（9.50 ± 3.32） ng/L,D group：（10.22 ± 5.14） ng/L than that of healthy control group （（5.49 ± 1.99） ng/L,P 〈 0.05）.The Serum CD62p levels in SAP patients were lower than that of NST-ACS patients （P 〈 0.05）.（2）The serum concentrations of CD62p in A and B groups at before taking clopidogrel were （7.62 ±2.99） ng/L and （8.48 ±3.13） ng/L respectively,higher than that four days after taking clopidogrel （（6.79 ± 2.51） ng/L,（6.37 ± 1.80） ng/L;t =2.390,4.520;P 〈0.05 or P 〈0.01）.There was no statistical significant difference between A and B groups（P 〉0.05）.（3） In C and D groups,the serum CD62p at before taking clopidogrel were （9.50 ±3.32） ng/L and （10.22 ±5.14） ng/L,higher than that after taking clopidogrel for four days （（8.21 ± 2.62） ng/L,（8.17 ± 2.37） ng/L; t =2.084,2.157 ; P 〈 0.05）.No significant difference was seen between C and D groups （P 〉 0.05）.Conclusion The serum CD62p in patients with CHD was higher than that in the healthy control.Clopidogrel administration can decrease serum CD62p in CHD patients.