老年心肌梗死患者溶栓治疗后血小板功能改变的意义  

Changes of platelet function after thrombolysis for acute myocardial infarction in elderly

作　　者：张萍[1] 高秉新[1] 赵兴山[1] 楚卡琳[1] 范丽雯[1] 

机构地区：[1]北京大学第四临床医院北京积水潭医院内科,北京100035

出　　处：《中国综合临床》2005年第11期963-965,共3页Clinical Medicine of China

摘　　要：目的探讨血栓素A2(TXA2)水平对静脉溶栓老年患者血小板活性的影响,并从血小板活性改变探讨可能的影响原因。方法50例急性心肌梗死患者中老年未溶栓组16例,只接受常规治疗;老年溶栓组14例;青年溶栓组20例。均于入院即刻口服阿司匹林0.3g,1次/d,共3d;后改为0.1g,1次/d。老年未溶栓组接受常规治疗;其他两组在心肌梗死6h内接受溶栓治疗,并于入院即刻、发病后24h、第7天分别测定TXA2代谢产物TXB2、前列环素代谢产物6-酮-前列腺素F1α血浆水平。结果3组患者发病后24hTXB2水平较各自入院即刻明显升高;入院第7天老年未溶栓组、青年溶栓组TXB2水平均下降至入院即刻水平;而老年溶栓组TXB2水平持续升高,差异有显著性(P<0.01)。结论溶栓早期血小板活性明显升高,老年人心肌梗死溶栓后可持续达1周;因此溶栓后应加强抗血小板治疗,溶栓后老年人这种血小板活性持续增强可能与溶栓后更易造成老年阿司匹林抵抗有关。Objective To investigate the effect of thromboxane A2 （ TXA2 ） levels on platelet activation of elderly patients after thrombolysis and to explore the possible cause of platelet activation changes. Methods In 50 cases of acute myocardial infarction, 16 cases without thrombolysis received routine treatment. 14 elderly patients and 20 young cases received thrombolysis treatment. The patients took 0.3 g aspirin orally,once a clay,for 3 days and then 0. 1 g,once a day. Elderly and young groups underwent thrombolysis within 6 h following myocardial infarction. The levels of TXB2 , which was the metabolitic production of TXA2 , and 6-keto-PCF1α were measured immediately on admission,24 h and 7 days after onset. Results 24 h TXB2 levels in the three groups were significantly increased at 24 h after onset as compared with those on admission,which decreased to the levels immediately on admission fn elderly group without thrombolysis and young group, however, which significantly increased continuously in elderly group with thrombolysis （ P 〈 0.01 ）. Conclusion In the early stage of thrombolysis therapy,the platelet activation is increased and which can be kept for a wcek .after thrombolysis in the elderly patients,so antiplatelet therapy should be strengthened after thrombolysis. Continuous enhancement of platelet activation in elderly patients after thrombolysis maybe related to aspirin resistance in elderly.

关 键 词：急性心肌梗死 血小板活性 血栓素A2 阿司匹林抵抗 

分 类 号：R542.22[医药卫生—心血管疾病]