梗死前心绞痛对ST段抬高型心肌梗死患者经皮冠状动脉介入术治疗后血小板活性的影响

Effect of pre-infarction angina pectoris on platelet activation after percutaneous coronary intervention in patients with ST-segment elevation myocardia infarction

目的探讨梗死前心绞痛对ST段型抬高心肌梗死(ST-elevated myocardial infarction,STEMI)患者血小板活性的影响.方法选取2015年8月至2017年8月期间在延安市人民医院接受直接经皮冠状动脉介入术治疗的急性STEMI首次发作患者223例,根据是否发生梗死前心绞痛分为梗死前心绞痛(pre-infarction angina,PIA)组和非PIA组,采用流式细胞仪对急性期住院时和1个月后随访时接受和未接受二磷酸腺苷活化的血小板活性进行评估,测定单核细胞-血小板聚集率以及血小板表面血小板膜糖蛋白Ⅱb/Ⅲa(platelet surface expression of glycoproteinⅡb/Ⅲa,CD41)和纤维蛋白原受体(fobrinogen receptor,PAC-1)的表达率.结果在急性期,PIA组患者接受和未接受二磷酸腺苷活化的样本单核细胞-血小板聚集率[分别为(28.51±2.83)%和(22.01±1.60)%]以及CD41(分别为197.62±34.20和158.20±25.50)和PAC-1(分别为10.38±2.48和6.93±2.29),平均荧光密度显著低于非PIA组[单核细胞-血小板聚集率分别为(26.22±4.20)%和(32.63±4.50)%,CD41分别为175.42±20.21和240.34±70.70,PAC-1分别为9.74±3.10和15.24±3.73](P均<0.05).1个月后随访期上述变量两组间差异无统计学意义.结论首次STEMI发作前出现PIA的患者血小板活性低于未出现PIA的患者.

Objective To investigate the effect of pre-infarction angina on platelet activity in patients with ST-segment elevation myocardial infarction(STEML).Methods Patients with acute STEMl who underwent primary percutangous coronary intervention in Yan'an People's Hospital from August 2015 to August 2017 were selected and divided into PIA group and non-PIAgroup according to whether pre-infarction angina(PIA)occurred or not.Flow cytometry was used to evaluate the activity of platelets stimulated with or without adenosine diphosphate during hospitalization and follow-up after one month;the monocyte-platelet aggregation rates(MPARS),platelet glycoproteinll b/Ⅲa(CD41)and fibrinogen receptor(PAC-1)expression rates were determined.Results In the acute phase,for patients in the PIA group with or without adenosine diphosphate stimulation,the MPARS[(22.01±1.60)%and(28.51±2.83)%,respectively];mean fluorescence density of CD41(158.20±25.50 and 197.62±34.20,respectively)and PAC-1(6.9312.29 and 10.38±2.48 respectively)were significantly lower than non-PlA group[MPARS were(26.22±4.20)% and(32.63±4.50)%,CD41 were 175.42±20.21 and 240.34±70.70,PAC-1 were 9.74±3.10 and 15.24±3.73,respectively,all P<0.05].There were no significant differences of the indexes above between the two groups in follow-up period.Conclusion The platelet activity in patients with PIA prior to the first STEMI episode was lower than that in patients without PIA.