介入治疗对冠心病患者血小板活化指标和抗血小板治疗效果及预后的影响研究  

Impact of Interventional Therapy on Platelet Activation Indices, Efficacy of Antiplatelet Therapy and Prognosis in Patients with Coronary Heart Disease

作　　者：王志军 王硕 王泽宇 周建芝 方晓明 李素新 黄宇玲 李海涛 

机构地区：[1]华北理工大学附属医院心血管内科,河北省唐山市063000 [2]华北理工大学校医院内科,河北省唐山市063000

出　　处：《中国全科医学》2017年第33期4125-4129,共5页Chinese General Practice

基　　金：河北省卫生厅医学研究重点课题计划项目(20100474)

摘　　要：目的分析介入治疗对冠心病(CHD)患者血小板活化指标、抗血小板治疗效果及预后的影响。方法选取2014年7月—2015年6月华北理工大学附属医院心内科符合纳入标准的CHD患者270例,根据患者病情、冠状动脉造影结果及意愿,将患者分为非介入组124例(单纯药物治疗)、介入组146例(药物治疗+支架置入)。收集患者一般资料,检测两组患者血液生化指标、血小板活化指标及超敏C反应蛋白(hs-CRP),分析抗血小板治疗效果,记录主要不良心血管事件(MACE)发生率及再住院率。结果介入组患者6酮前列腺素F1a(PGF)较非介入组降低,P选择素(PS)、花生四烯酸(AA)诱导的最大血小板聚集率(MPAR),d TP及hs-CRP较非介入组升高(P<0.05)。介入组患者抗血小板治疗效果劣于非介入组(P<0.05)。非介入组患者MACE发生率(28.2%,35/124)与介入组(32.2%,47/146)比较,差异无统计学意义(P>0.05)。非介入组患者再住院率(12.1%,15/124)与介入组(18.5%,27/146)比较,差异无统计学意义(P>0.05)。结论介入治疗可促进血小板活化及炎性反应,诱发抗血小板药物抵抗,但并未增加MACE发生率及再住院率。对于接受介入治疗的CHD患者应该强化联合抗血小板治疗。Objective To examine the impact of interventional therapy on platelet activation indices,efficacy of antiplatelet therapy and prognosis in patients with coronary heart disease（ CHD）. Methods A total of 270 patients with CHD who were admitted to the Department of Cardiology of the Affiliated Hospital of North China University of Science and Technology from July 2014 to June 2015 were enrolled in this study. All subjects were assigned to one of two groups according to disease condition,results of coronary angiogram and individual preference. Patients in the non-interventional group（ n = 124） were given drug therapy alone, while subjects in the interventional group（ n = 146） received drug therapy plus stent implantation. General characteristics were collected for all patients,and blood biochemical parameters,platelet activation indices and high-sensitivity C-reaction protein（ hs-CRP） were measured and compared between the two groups. The efficacy of antiplatelet therapy was evaluated and the incidence of major adverse cardiovascular events（ MACE） and rehospitalization rates were recorded. Results Levels of 6-keto-prostaglandin F1 a（ PGF） were lower in the interventional group than in the non-interventional group and P-selectin（ PS）,the maximum platelet aggregation rate（ MPAR） induced by arachidonic acid（ AA）,d TP and hs-CRP were higher in the interventional group than in the non-interventional group（ P 0. 05）. Antiplatelet therapy was found to be less effective in the interventional group compared with the non-interventional group（ P 0. 05）,although there were no significant differences in the incidence of MACE [28. 2%（ 35/124） in the non-interventional group and 32. 2%（ 47/146） in the interventional group,P 0. 05] or rehospitalization rates [12. 1%（ 15/124） in the non-interventional group and18. 5%（ 27/146） in the interventional group,P 0. 05 ]between the two groups. Conclusion Interventional therapy may promote platelet activation and inflammatory reactio

关 键 词：冠心病 血小板活化 随访研究 放射摄影术 介入性 

分 类 号：R541.4[医药卫生—心血管疾病]