冠状动脉介入术对血小板活性的影响及与支架血栓的关系  

Effect of Sirolimus-eluting stents implantation on platelet activation under dual anti-platelet therapy

作　　者：薛朝阳[1,2] 陈媛[1,2] 陆民[1,2] 

机构地区：[1]银川市第一人民医院 [2]宁夏医学院第二附属医院心内科,银川市750001

出　　处：《中国介入心脏病学杂志》2009年第6期320-323,共4页Chinese Journal of Interventional Cardiology

基　　金：宁夏回族自治区自然科学基金项目(NZD7112)

摘　　要：目的观察双联抗血小板基础上PCI前后动脉系统血小板活性的变化及与支架血栓的关系。方法20例行支架置入术的稳定性冠心病患者为PCI组,另20例单纯行冠状动脉造影术(CAG)者为对照组。测定术前及术后不同时间段外周动脉全血血小板纤维蛋白原受体ⅡbⅢa(plate-let fibrinogen receptor expression,PAC-1)、P选择素(P-selectin,CD62P)及动脉血浆各时间点内皮素(endothlin,ET-1)血栓素B2(thromboxane B2,TXB2)、纤维蛋白原(fibrinogen,FIB),并观察围术期及随访期严重心血管不良事件(main adverse cardiac events,MACE)发生率。结果在PCI组,术后6h与术前比较,PAC-1(2.626%±1.597%比1.388%±0.764%,P=0.001)、CD62P(0.363%±0.204%比0.213%±0.176%,P=0.007)、PAC-1+CD62P(0.261%±0.181%比0.133%±0.121%,P=0.003)差异有统计学意义。TXB2在PCI术后24小时与术前比较差异有统计学意义(474.84±190.43ng/mL比310.37±184.21ng/mL,P=0.021)。ET-1、FIB手术前后无明显变化。在CAG组,上述各指标CAG术前后无明显变化。两组均无MACE发生。结论对已采取标准双联抗血小板患者,PCI术仍可引起全身血小板激活,但对凝血功能及内皮功能无明显影响。Objective To investigate the changes in platele aciveation in terms of platelet fibrinogen receptor expression （ PAC-1 ） , P-selectin （CD62P） , Thromboxane B2 （ TXB2 ） , Endothlin （ ET-1 ） , Fibrinogen （FIB） in patients undergoing elective Sirolimus-eluting stents implantation and dual anti-platelet therapy. Methods Forty in-hospital patients with stable coronary heart disease （CHD） were enrolled in this study. Dural anti-platelet therapy with aspirin and clopidogrel were prescribed at least three days before operation to achieve sufficient inhibition of platelet activation in all patients. Peripheral artery blood samples were collected before the procedures, immediately and at 6 hours and 24 hours after the procedure, levels of PAC-1 , CD62P, TXB2, ET-1 and FIB were measured. All patients were followed up for 6 - 12 months. Results Expression of PAC-I and CD62P was increased significantly after stenting compared with prestenting and the peak appeared at 6 hours post-operation （ PAC-1, P =0. 001, CD62P, P =0. 007, PACI ＋ CD62P, P = 0. 003）. TXB, was also increased and the peak appeared at 24 hours post operation （P = 0.021）. Plasma levels of ET-1 and FIB showed no difference before and after stenting. After CAG, expression of PAC-1 and CD62P, levels of TXB2, ET-I and FIB had no significant differences compared with pre-CAG. No MACE happened in all patients. Conclusion The routine dual anti-platelet therapy cannot suppress platelet activation after elective coronary Sirolimus-eluting stents implantation. Plasma FIB and ET-1 levels were not affected by stems implantation.

关 键 词：血管成形术 经腔 经皮冠状动脉 支架 血小板活化 内皮缩血管肽类 

分 类 号：R541.4[医药卫生—心血管疾病] R54[医药卫生—内科学]