不同抗栓治疗模式对房颤患者体内血小板活化的影响  

Effects of different antithrombotic therapy on platelet activation in patients with nonvalvular atrial fibrillation

作　　者：于占彩[1] 李振光[1] 伍期专[2] 王道珍[1] 鞠卫萍[1] 王远臣[1] 詹霞[1] 吴喜娟[1] 周丽[1] 唐朝枢[3] 

机构地区：[1]潍坊医学院附属文登中心医院神经内科,山东省264400 [2]北京大学第一医院神经生化室 [3]北京大学第一医院中心实验室

出　　处：《中华临床医师杂志（电子版）》2008年第3期8-12,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家"973"基金资助项目(G2000056905)

摘　　要：目的观察不同抗栓方式对非瓣膜性心房颤动（NVAF）患者血浆溶血磷脂酸（LPA）含量变化的影响，为临床进行抗栓治疗提供依据。方法235例未接受抗栓治疗的NVAF患者，随机分为阿司匹林／双嘧达莫治疗组（A组）、阿司匹林／固定剂量华法林治疗组（B组）及适宜剂量华法林治疗组（C组）。测定治疗前、治疗后2周和6周血浆LPA含量，分析各年龄亚组的变化并进行疗效比较。结果B组在2周和6周后血浆LPA含量的降低幅度均显著大于其他两组：A组中〈60岁年龄亚组血浆LPA在2周和6周后均较治疗前显著降低，其他曲个年龄亚组治疗前后无显著变化；B组的〈60岁和60～75岁年龄亚组的血浆LPA含量在2周和6周后均较治疗前显著降低，〉75岁年龄组在治疗前后则无显著变化；C组符年龄亚组的山浆LPA含量在2周和6周后均较治疗前显著降低。结论不同抗栓治疗方式对不同年龄段NVAF患者体内血小板活化有不同影响。小于60岁者可给予阿司匹林联合双嘧达莫治疗，60～75岁的患者可给予阿司匹林联合固定剂量华法林治疗，大于75岁的患者推荐应用适宜剂量的华法林（INR1．5～2．1）治疗。Objective The aim of this study was to investigate new aspects of platelet biology, in nonvalvular atrial fibrillation （NVAF）, predominantly focusing on platelet activation and the effects of concomitant antiplatelet and anticoagulant therapy. Methods The 235 patients with NVAF, who were not receiving any antithrombotic therapy, were divided randomly into 3 groups： group A including 76 patients treated with aspirin （ 100 mg/d ） plus dipyridamole （ 100 mg/d ） , group B including 79 patients taking aspirin （ 100 mg/d ） in combination with fixed-dose warfarin（ 1. 25 mg/d） and group C including 80 patients treated with dose-adjusted warfarin [ International Normalised Ratio （INR） range was regulated from 1.5 to 2. 1 ]. The patients＇ plasma levels of lysophosphatidic acid（LPA） were measured before therapy,2 weeks and 6 weeks after therapy respectively, and the LPA levels in different groups or age-subgroups were analyzed. Results LPA levels were significantly decreased in group B by treatment with aspirin in combination with fixed-dose warfarin for 2 weeks or 6 weeks comparing to group A or C（ P 〈0.01 ,P 〈0. 01 ）. LPA levels were significantly decreased in age 〈 60 years subset （group A） by treatment with aspirin plus dipyridamole for 2 weeks or 6 weeks comparing to not yet on therapy（ P 〈0. 01 ,P 〈0. O1 ） ,however,other two age subsets were no significant difference. LPA levels were significantly lowered both in age 〈 60 years subset and 60 - 75 years subset（group B） by treatment with aspirin in combination with fixed-dose warfarin for 2 weeks or 6 weeks comparing with before administration（P 〈 0. 01 ,P 〈 0. 01 ）. LPA levels were significantly decreased in 3 subsets（group C） patients treated with dose-adjusted warfarin （INR range 1.5 - 2. 1 ） for 2 weeks or 6 weeks. Conclusions The measurement of plasma levels of LPA may reflect platelet activity in patients with NVAF. Effects of antiplatelet drugs or/and anticoagulants on platelet activation

关 键 词：心房颤动 血栓溶解疗法 溶血磷脂素类 血小板活化 

分 类 号：R541.75[医药卫生—心血管疾病]