介入治疗对急性冠脉综合征患者血小板活化及炎症因子的影响

Influence of percutaneous coronary intervention on platelet activating and inflammatory factors in patients with acute coronary syndrome

目的探讨介入治疗对急性冠脉综合征患者血小板活化及炎症因子的影响。方法选择2013年5月~2015年5月我院心内科急诊行经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)的患者128例,所有患者均术前嚼服阿司匹林及氯吡格雷,行PCI治疗,术后常规应用如上药物及采用相应治疗。记录患者治疗前后血小板活化因子GPⅡb/Ⅲa、CD62p、CD63,炎症因子hs-CRP、IL-6以及内皮细胞受损标志v WF、ET-1、NO的表达水平。结果所有患者术后1 d血小板活化因子GPⅡb/Ⅲa、CD62p、CD63均高表达于术前,而术后7 d至术后28 d呈现下降趋势,术后7 d与术后1 d及术前相比有所下降,术后28 d下降更加明显,差异均有统计学意义(P<0.05)。所有患者术后1 d相关炎症因子hs-CRP、IL-6均高表达于术前,而术后7 d至术后28 d呈现下降趋势,hs-CRP术后7 d与术后1 d相比有所下降,术后28 d下降更加明显,IL-6术后28 d与术前相比有所下降,差异均有统计学意义(P<0.05)。所有患者术后1 d血小板活化因子NO低于术前,术后7 d至术后28 d呈现升高趋势,与术前相比显著升高,ET-1、v WF均高表达于术前,而术后7 d至术后28 d呈现下降趋势,术后7 d与术后1 d及术前相比有所下降,术后28 d下降更加明显,差异均有统计学意义(P<0.05)。结论介入治疗相对急性冠脉综合治疗,虽然在术后存在出现并发症等一定风险,但是随着预防并发症的治疗,风险可在短期内降低,但针对术后患者生存质量及远期疗效等方面还需要进一步观察。

Objective To discuss the influence 6f percutaneous coronary intervention（PCI） on platelet activating and in- flammatory factors in patients with acute coronary syndrome（ACS）. Methods 128 patients who were given emergency PCI in our department from May 2013 to May 2015 were selected. All patients were given aspirin and clopidogrel for chewing administration before operation. Routine application of the above drugs and corresponding treatment were con- ducted after PCI. The expression levels of platelet activating factors including GP Ⅱ b/Ⅲ a, CD62p, and CD63, and in- flammatory factors including hs＇CRP and IL-6, as well as endothelial cells injury markers including vWF, ET-1, and NO before and after treatment were recorded. Results On 1 day after operation, the expression levels of platelet activating factors including GP Ⅱb/Ⅲ a, CD62p, and CD63 were all higher than those before operation, which showed a declining tendency from 7 d to 28 d after operation. The levels of those factors were significantly lower at 7 d after operation, and more significantly lower at 28 d after operation, when compared to those at 1 d after operation （P〈0.05）. The expression levels of inflammatory factors including hs-CRP and IL-6 in all patients were significantly higher at 1 d after operation than before operation, which showed a declining tendency from 7 d to 28 d after operation. The level of hs-CRP.was significantly lower at 7 d after operation, and more significantly lower at 28 d after operation, when compared to that at 1 d after operation（P〈0.05）. The level of IL-6 was significant lower at 28 d after operation than that before operation（P〈0.05）. The levels of NO at I d after operation were all lower than that before operation, which showed a increasing tendency from 7 d to 28 d after operation, was significantly higher compared with before operation. The levels of ET-I,： and vWF at 1 d after operation were all higher than those before operation, which showed a declining tendency from 7 d to 28 d after operation. The levels of those factors were significantly lower at 7 d after operation, and more signifi cantly lower at 28 d after operation, when compared to those before operation and at 1 d after operation（P〈0.05）. Con-clusion Though there are risks of postoperative complications when applying PCI in ACS, by prevention of complica- tions, the risks can be lowered. More observation is required as to the life quality and long-term efficacy in patients af- ter operation.