封堵器对先天性心脏病封堵患者血小板功能的影响

Occluder effects on platelet function of patients with congenital heart disease undergoing transcatheter closure

背景:封堵器植入先天性心脏病患者体内后会增加血小板的黏附聚集,造成封堵器表面血栓形成。目的:探讨先天性心脏病封堵术后封堵器对患者血小板功能的影响。方法:回顾性分析124例先天性心脏病封堵患者的临床资料,其中房间隔缺损组46例、动脉导管未闭组43例及室间隔缺损组35例,均采用封堵器封堵。封堵前、封堵后6 h、封堵后24 h、封堵后12个月对比3组外周血中CD62p、CD63和凝血酶敏感蛋白的阳性表达率。结果与结论:封堵前3组外周血中CD62p、CD63和凝血酶敏感蛋白阳性表达率差异无显著性意义。3组外周血中CD62p、CD63和凝血酶敏感蛋白水平均于封堵后6 h达到最高值,尤以房间隔缺损组及室间隔缺损组升高显著,之后逐渐下降;至12个月时,动脉导管未闭组、室间隔缺损组CD62p、CD63水平恢复至封堵前水平,而房间隔缺损组CD62p、CD63水平仍保持在较高水平,并且明显高于动脉导管未闭组、室间隔缺损组(P<0.05);3组间不同时间点凝血酶敏感蛋白水平比较差异无显著性意义。表明封堵器植入后,先天性房间隔缺损与室间隔缺损患者血小板功能活化明显,尤以房间隔缺损更甚,持续时间更长。

BACKGROUND：Occluder implantation in patients with congenital heart disease can increase in vivo platelet adhesion and aggregation, resulting in thrombosis on the occluder surface. OBJECTIVE：To investigate the effect of the occluder on platelet function in patients with congenital heart disease undergoing transcatheter closure. METHODS： Clinical data from 124 patients with congenital heart disease undergoing transcatheter closure were retrospectively analyzed. These patients were divided into groups of atrial septal defect in 46 cases, patent ductus arteriosus in 43 cases and ventricular septal defect in 35 cases according to the types of congenital heart disease. The positive rates for peripheral blood CD62p, CD63 RESULTS AND CONCLUSION：There was no difference in the positive rates of peripheral blood CD and thrombin sensitive protein were compared before and 6 hours, 24 hours, 12 months after occluder implantation. 62p, CD63 and thrombin sensitive protein among three groups prior to occluder implantation. Up to 6 hours after occluder implantation, the expression levels of peripheral blood CD62p, CD63 and thrombin sensitive protein reached peak in the three groups, especialy in the patients with atrial septal defect and ventricular septal defect, then gradualy decreased. After 12 months, the expression levels of CD62p and CD63 recovered in the patients with patent ductus arteriosus and ventricular septal defect, but stil maintained a higher level in those with atrial septal defect （P 〈 0.05）. The expression of thrombin sensitive protein showed no difference among the three groups at different time. These findings indicate that after occluder implantation, the platelet activation is more remarkable and lasts longer in the patients with atrial septal defect and ventricular septal defect, especialy in those with ventricular septal defect.