PTCA围手术期硫氮酮对血小板活性和钙动力学的影响  

Effects of diltiazem on platelet activation and cytosolic calcium during percutaneous transluminal coronary angioplasty

作　　者：戴禾敏[1] 陈君柱[1] 陶谦民[1] 朱建华[1] 张芙荣[1] 郑良荣[1] 邱原刚[1] 

机构地区：[1]浙江大学医学院附属第一医院心内科,浙江杭州310031

出　　处：《中国病理生理杂志》2004年第7期1286-1289,共4页Chinese Journal of Pathophysiology

基　　金：浙江省医药卫生科学研究基金资助项目 (No .98A0 2 3)

摘　　要：目的 :研究硫氮  酮对内皮损伤后血小板激活的影响及与胞浆Ca2 + 浓度的关系。方法 :35例拟行PTCA治疗的心绞痛患者随机分成对照 (C)组和硫氮 艹卓 酮治疗 (D)组 ,由冠状静脉窦和外周静脉采血 ,检测围术期血小板GPⅡb/Ⅲa表达和胞浆Ca2 + 浓度。并在体外研究不同浓度硫氮 艹卓 酮对稳定型心绞痛患者全血GPⅡb/Ⅲa表达的影响。结果 :C组首次球囊扩张后 5min、10min和PTCA后 10min时GPⅡb/Ⅲa表达和 [Ca2 + ]i明显升高 ,而D组未见升高。高于治疗浓度的硫氮 艹卓 酮 (2 0 0 μg/L以上 )显著抑制GPⅡb/Ⅲa表达。 结论 :硫氮 艹卓 酮和阿司匹林 /抵克力得联合治疗可防止常规阿司匹林 /抵克力得治疗时发生的血小板激活。硫氮 艹卓 酮抗血小板作用可能是抑制[Ca2 + ]i升高的结果 。AIM: To evaluate effects of diltiazem on platelet hyperreactivity in situations associated with endothelial injury and their possible relationship to cytosolic calcium concentration. METHODS: Blood samples were collected at 7 time points from 35 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) who received combined diltiazem and aspirin/ticlopidine therapy or aspirin/ticlopidine therapy alone. Platelet expression of glycoprotein Ⅱb/Ⅲa and cytosolic calcium concentration were measured, respectively, by whole blood flow cytometry and fluorospectrophotometry. The effects of diltiazem of different concentrations on expression of glycoprotein Ⅱb/Ⅲa were also studied in vitro in blood samples from patients with chronic stable angina. RESULTS: Of the two treatments, aspirin/ticlopidine therapy did not prevent an acute increase of expression of glycoprotein Ⅱb/Ⅲa 5 minutes and 10 minutes after first inflation and 10 minutes after PTCA, whereas combined diltiazem and aspirin/ticlopidine therapy had a significant inhibitory effect. In the group receiving aspirin/ticlopidine therapy, there was a short-term elevation of platelet [Ca^(2+)]i immediately following PTCA which was significantly reduced by diltiazem treatment. Expression of glycoprotein Ⅱb/Ⅲa was significantly inhibited in vitro by diltiazem in the concentration of 200 μg/L or higher, but not 50 μg/L. CONCLUSIONS: Combined diltiazem and aspirin/ticlopidine therapy significantly inhibited platelet activation that continued in the presence of conventional aspirin/ticlopidine treatment. Antiplatelet effects of diltiazem were probably a consequence of reduction of platelet [Ca^(2+)]i and may only be achieved in higher than therapeutic concentrations. [

关 键 词：血管成形术 经腔 经皮冠状动脉 血小板 地尔硫革 钙 

分 类 号：R363[医药卫生—病理学]