瑞替普酶与阿昔单抗联合治疗对急性心肌梗死患者血小板活化的影响  

Effect of Combination Therapy of Reteplase plus Abciximab on Platelet Activation in Patients with Acute Myocardial Infarction

作　　者：汤祥瑞 孙超峰[1] 

机构地区：[1]西安交通大学第一附属医院心内科,陕西西安710061

出　　处：《中国医院用药评价与分析》2015年第7期871-874,共4页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:探讨瑞替普酶(r-PA)与阿昔单抗联合溶栓治疗对急性心肌梗死(acute myocardial infarction,AMI)患者血小板活化及止血/纤溶系统的影响。方法:选取2014年西安交通大学第一附属医院心内科治疗的38例AMI患者,以随机数字表法分为半剂量r-PA+阿昔单抗组(联合治疗组,n=20)、全剂量r-PA组(r-PA治疗组,n=18),对比观察2组患者血小板计数、中性粒细胞百分比、单核细胞及可溶性血小板选择细胞的相互作用和活化标记的膜黏附分子(CD41、CD42b、CD40、CD40L)水平。另选取28名健康人作为对照组。结果:联合治疗组患者48 h的可溶性P-选择素水平显著低于r-PA治疗组(P<0.05);治疗3 h后,联合治疗组患者的CD41和CD42b阳性单核细胞和粒细胞百分比、CD40阳性粒细胞百分比和CD40L阳性单核细胞百分比均较r-PA治疗组显著减少(P<0.01,P<0.05)。结论:半剂量r-PA与阿昔单抗联合溶栓治疗AMI,有利于血小板活化,与r-PA单药治疗相比,联合治疗可显著减少血小板-单核细胞及部分血小板-粒细胞聚集,有助于减少单核细胞活化状态,对单核细胞-内皮黏附有积极作用,还可减少急性局部炎性过程以及降低血小板-粒细胞聚集与内皮下膜的黏附。OBJECTIVE： To study the effect of the combined thrombolytic therapy of reteplase（ r-PA） plus abciximab on platelet activation and hemostatic / fibrinolytic system in patients with acute myocardial infarction（ AMI）. METHODS： A total of 38 AMI patients treated in cardiology department of The First Affiliated Hospital of Xi＇an Jiaotong University in 2014 were randomly assigned to received either half dose r-PA plus abciximab（ combined treatment group,n = 20） or full dose r-PA（ rPA group,n = 18）. The two groups of patients were followed with regard to platelet count,the percentage of neutrophils,interaction between monocytes and soluble platelet-selecting cell and levels of the activation-labeled membrane adhesion molecules（ CD41,CD42 b,CD40,CD40L）. Another 28 healthy volunteers were assigned to control group. RESULTS： The soluble P-selectin level at 48 hours was significantly lower in combined treatment group than in r-PA group（ P〈0. 05）; after treatment of 3 hours,in the combined treatment group,the percentages of positive mononuclear cells and granulocytes of CD41 and CD42 b,the percentage of CD40 positive granulocytes and the percentage of CD40 L positive mononuclear cells were decreased significantly as compared with r-PA group（ P〈0. 01,P〈0. 05）. CONCLUSIONS： The combined thrombolytic therapy of half dose reteplase plus cetuximab in treatment of AMI can facilitate platelet activation,significantly reduce the aggregation of platelet-monocyte and partial platelet granulocytes compared with reteplase alone,reduce monocyte activation state,contribute to monocyte-endothelial adhesion,and reduce the acute inflammatory process,platelet-granulocyte aggregation and subendothelium adhesion.

关 键 词：急性心肌梗死 瑞替普酶 阿昔单抗 血小板活化 

分 类 号：R973[医药卫生—药品]