替罗非班对急性冠脉综合征患者围手术期血小板和C反应蛋白的影响  

Influence of Tirofiban on the Platelet and C-reactive Protein in Patients with Acute Coronary Syndromes in Perioperative Period

作　　者：梁海峰[1] 杨明[1] 韩凌[1] 高亢[1] 赵燕[1] 陈萍[1] 李晓红[1] 

机构地区：[1]首都医科大学附属复兴医院心脏中心,北京100038

出　　处：《中国微循环》2009年第6期528-531,共4页Journal of Chinese Microcirculation

摘　　要：目的观察替罗非班对接受双重抗血小板治疗(阿司匹林+氯吡格雷)的不稳定型心绞痛、非ST段抬高心肌梗死(NSTE-ACS)患者,经皮冠状动脉介入治疗(PCI)围手术期血小板最大聚集率(mPAR)和高敏C反应蛋白(hs-CRP)的影响,探讨两者的相关性。方法125例行择期PCI的高危NSTE-ACS患者随机分为阿司匹林+氯吡格雷+替罗非班组(简称替罗非班组)、阿司匹林+氯吡格雷组(对照组)。替罗非班组患者在PCI前直接冠脉内弹丸式注射替罗非班10μg/kg,时间不少于3min,随后以0.15μg/(kg.min)-1持续泵点8h。检测两组患者PCI围手术期不同时间点mPAR及hs-CRP并分析两者的相关性。结果术前,替罗非班组与对照组mPAR、hs-CRP无统计学差异。术后6h,替罗非班组mPAR、hs-CRP低于术前及对照组;对照组mPAR较术前显著升高,hs-CRP虽较术前轻度升高,但无统计学差异。术后24h及术后7d,两组之间mPAR及hs-CRP无统计学差异。替罗非班组PCI围手术期不同时间点hs-CRP对数值与mPAR呈直线相关。术前及术后24h,对照组hs-CRP对数值与mPAR呈直线相关。术后6h及术后7d,对照组未见相关关系。结论PCI术后6h,在双重抗血小板治疗的基础上,替罗非班对接受PCI术的NSTE-ACS患者的血小板功能和炎症反应有抑制作用;mPAR与hs-CRP呈正相关,hs-CRP对血小板的聚集状态有一定的预测价值。Objective To test the influence of tirofiban on the platelet activation and high-sensitivity C-reactive protein （hs-CRP） in patients with unstable angina pectoris and non-ST-segment elevation myocardial infarction （NSTE-ACS） after percutaneous coronary intervention （PCI） receiving dual anti-platelet （ aspirin ＋ clopidogrel） therapy. Moreover, the correlation of between hs-CRP and mPAR is assessed during follow-up. Methods 125 patients with NSTE -ACS were randomly divided into two groups： dual anti-platelet therapy ＋ tirofiban versus receiving dual anti-platelet therapy. In tirofiban group, 10μg/kg tirofiban was injected into coronary artery in each patient. The time was not shorter than 3 minutes. And then 0.15μg/kg. min tirofiban was pumped into venous for 8 hours. The mPAR and hs-CRP were measured at different time points in perioperative period. A correlation analysis was performed between mPAR and hs-CRP. Results The mPAR and the hs-CRP in pre-PCI operation of two groups had no significant differences. 6 hours after PCI, the mPAR and the hs-CRP were reduced in tirofiban group compared with pre-PCI operation and control group. In control group, the mPAR was significantly higher than pre-PCI, the hs-CRP had no significant differences compared with pre-PCI operation. 24 hours and 7 days after PCI, no significant differences could be observed in the mPAR and hs-CRP of two groups. The hs-CRP was positively correlated with mPAR in tirofiban group at different time points in perioperative period. In control group, the hs-CRP was positively correlated with mPAR in pre-PCI operation and 24 hours post-PCI; the correlation was not found in 6 hours post-PCI and 7days post-PCI. Con- chtsion On the basis of double anti-platelet treatment, the platelet function is further inhibited by tirofiban in patients with NSTE-ACS 6 hours after PCI. The levels of hs-CRP have a predictive value for platelet function to some extent.

关 键 词：急性冠脉综合征 经皮冠状动脉介入治疗 替罗非班 血小板最大聚集率 高敏C反应 蛋白 

分 类 号：R543.3[医药卫生—心血管疾病]