急性冠脉综合征患者冠脉血小板微粒水平

Level of coronary platelet microparticles in patients with acute coronary syndrome

目的利用流式细胞法检测急性冠脉综合征(ACS)患者冠状动脉血中血小板微粒(PMPs)水平,探索其与冠心病发生发展的关系及其机制。方法入选患者共92例分为4组,其中ST段抬高型急性心肌梗死(STEAMI)组28例,非ST段抬高型急性冠脉综合征(NSTE-ACS)组24例,稳定型心绞痛(SA)组20例,正常对照组20例。冠脉造影术中取冠脉内血液3 ml,离心制得贫血小板血浆,依次加入CD61荧光抗体及0.82μm标准微球,流式细胞仪测定PMPs的相对水平。结果 STEAMI组、NSTEACS组PMPs水平(分别为8.9%±3.3%,7.8%±2.4%)均高于正常组(4.7%±2.9%);STEAMI组、NSTE-ACS组也均高于SA组(5.9%±2.6%,P均<0.05)。STEAMI组和NSTE-ACS组组间比较、SA组和冠脉正常组组间比较,差异无统计学意义(P均>0.05)。结论 ACS患者冠脉血中的PMPs水平明显升高,稳定性心绞痛患者PMPs无明显升高,提示PMPs与冠心病发生发展有关。其机制可能通过PMPs与血小板的相互激活,导致动脉粥样硬化进程的加速。检测PMPs水平可能有助于高危ACS患者的早期诊断。

Objective To detect the level of coronary platelet microparticles （PMP） in patients with acute coronary syndrome （ACS） by applying flow cytometry, and investigate the relationship between PMP and development of ACS and mechanism. Methods The patients （n=92） were divided into 4 groups including group of ST-segment elevation acute myocardial infarction （STEAMI group, n=28）, group of non-ST-segment elevation ACS （NSTE-ACS group, n=24）, group of stable angina （SA group, n=20） and normal group （n=20）. The blood samples （3 mL） were collected from coronary artery, and platelet-poor plasma was obtained after centrifugation. CD61 fluorescent antibody and standard microsphere （0.82μm） were successively added into the plasma, and relative level of PMP was detected by using flow cytometry. Results The level of PMP was higher in STEAMI group （8.9%±3.3%） and NSTE-ACS group （7.8%±2.4%） than that in normal group （4.7%±2.9%）, and also higher in STEAMI group and NSTE-ACS group than that in SA group （5.9%±2.6%, all P〈0.05）. The comparison between STEAMI group and NSTE-ACS group, and between SA group and normal group showed that the difference had no statistical significance （all P〉0.05）. Conclusion The level of PMP increases significantly in patients with ACS and has no significant changes in those with stable angina, which indicates that PMP is related to the development of CHD. The mechanism may be related to the mutual activation of PMP and platelet and acceleration of atherosclerosis process. The detection of PMP level is helpful to the early diagnosis of high-risk ACS.