冠状动脉介入术围术期血小板膜糖蛋白表达水平的变化及其临床意义  

Changes in Plasma Levels of Platelet Glycoprotein in Patients Undergoing Percutaneous Coronary Intervention

作　　者：姚建华[1,2] 王豪[2] 陈德[2] 许嘉鸿[3] 马瑾[2] 王蕊[2] 王渊铭[2] 陈楠楠[2] 张书富[2] 

机构地区：[1]同济大学医学院,上海200092 [2]上海市杨浦区中心医院心内科,上海200090 [3]同济大学附属同济医院,上海200065

出　　处：《中国临床医学》2012年第4期347-349,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:动态观察急性冠状动脉综合征(acute coronary syndrome,ACS)患者介入术前、术后血浆中血小板膜糖蛋白Ⅱb/Ⅲa(platelet glycoproteinⅡb/Ⅲa,GPⅡb/Ⅲa)、血小板膜糖蛋白Ⅵ(platelet glycoprotein Ⅵ,GPⅥ)浓度的变化,探讨其临床意义。方法:将94例行冠状动脉造影的患者,根据其临床表现、心电图、血生化检查和冠状动脉造影结果分为肌钙蛋白T(tro-ponin T,TnT)阳性ACS组(TnT+ACS组,n=35)、TnT阴性ACS组(TnT-ACS组,n=38)和冠状动脉正常组(n=21)。采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)测定3组患者在冠状动脉介入术前即刻、术后6 h和术后24 h时间点的GPⅡb/Ⅲa和GPⅥ的浓度。结果:TnT+ACS组与TnT-ACS组和冠状动脉正常组比较,各个时间点的GPⅡb/Ⅲa浓度均显著升高(P<0.05)。TnT-ACS组中术后6 h的GPⅡb/Ⅲa的浓度显著高于术前和术后24 h(P<0.05)。TnT+ACS组术前、术后6 h及术后24 h的GPⅥ浓度均比冠状动脉正常组显著升高(P<0.05)。TnT+ACS组术后6 h及术后24 h的GPⅥ浓度较术前显著升高(P<0.05)。结论:动态检测血浆中GPⅡb/Ⅲa、GPⅥ浓度的变化能反映ACS患者体内血小板的活化情况,GPⅡb/Ⅲa和GPⅥ的检测对冠状动脉介入术后血栓形成的风险评估有一定临床意义。Objective：To study the changes of platelet glyeoprotein Ⅱ b/Ⅲ a（GPⅡ b/Ⅲ a） and platelet glycoprotein VI （GPⅥ） levels in the plasma from patients with acute coronary syndrome （ACS）. Methods： A total of 94 patients undergoing coronary angiography were enrolled. Based on clinical symptoms and results of blood biochemical examination, electrocardiogram and coronary angiography, patients were classified into three groups： troponin T （TnT） ＋ ACS group（n = 35）, TnT- ACS group （n = 38） and non-coronary disease group（n = 21）. Plasma levels of GP Ⅱ b/Ⅲ a and GPVI were measured by enzyme-linked im- munosorbent assay （ELISA） before percutaneous coronary intervention（PCI） surgery, as well as 6 hours and 24 hours after PCI surgery. Results ： The levels of GPⅡ b/m a were significantly higher in TnT ＋ ACS group at all three time points compared with TnT- ACS group and non-coronary disease group （P 〈 0. 05）. In TnT- ACS group, significantly higher level of GPⅡ b/Ⅲa was found at the time of 6 h after PCI compared with before surgery and 24 h after PCI（P〈0.05）. The levels of GPVI were significantly higher at all three time points in TnT ＋ ACS group compared with non-coronary disease group（P〈 0.05）, and the levels of GPVI in TnT ＋ ACS group at the time of 6 hours and 24 hours after surgery were significantly higher than before surgery （P〈0.05）. Conclusions： Measurement of GP Ⅱ b/Ⅲ a and GPⅥ is a valuable tool to identify the patients with high risks for coronary thrombosis.

关 键 词：血小板膜糖蛋白Ⅱb/Ⅲa 血小板膜糖蛋白Ⅵ 急性冠状动脉综合征 

分 类 号：R543.3[医药卫生—心血管疾病]