缺血后适应改善急性心肌梗死PCI术中血小板功能与临床预后的关系  

Study of platelet function and clinical prognosis during PCI in acute myocardial infarction with ischemic postconditioning

作　　者：吴方辉 刘金来[2] 张江武 谢志辉 许云耀 侯冬子 黄世安 WU Fanghui;LIU Jinlai;ZHANG Jiangwu;XIE Zhihui;XU Yunyao;HOU Dongzi;HUANG Shian(The Third Affiliated Hospital of Sun Yat-Sen University-Yuedong Hospital,Meizhou 514700,China)

机构地区：[1]中山大学附属第三医院粤东医院心血管内科,广东梅州514700 [2]中山大学附属第三医院心血管内科,广州510630

出　　处：《实用医学杂志》2018年第11期1872-1875,共4页The Journal of Practical Medicine

基　　金：梅州市市级医研类科技计划项目(编号:2016B118)

摘　　要：目的旨在分析远端缺血后适应改善急性心肌梗死(AMI)患者接受急诊支架置入术(PCI)治疗对血小板功能及临床预后的影响。方法共纳入71例AMI患者接受急诊PCI治疗,随机分为对照组34例和观察组37例,观察组给予远端缺血后适应;分别于PCI术前、干预即刻、PCI术后24 h和48 h,采用流式细胞术检测血小板α颗粒膜糖蛋白(CD62P)和活化的Ⅱb/Ⅲa(PAC-1)百分率,采用比浊法检测二磷酸腺苷(ADP)和花生四烯酸(AA)诱导的血小板最大聚集率,随访6.0个月,比较两组的主要心脏不良事件(MACE)发生率。结果观察组PCI术后24 h的CD62P百分率明显低于对照组(P<0.05),其他时间点比较无差异(P>0.05)。两组PAC-1百分率在各个时间点比较差异无统计学意义(P>0.05)。ADP和AA诱导的血小板最大聚集率在各个时间点比较差异也无统计学意义(P>0.05)。观察组的MACE发生率低于对照组,差异有统计学意义(P<0.05)。结论远端缺血后适应可以降低AMI患者急诊PCI治疗的近期MACE发生率,可能与改善血小板CD62P的活化程度有关。Objective It was main treatment of opening culprit vessel and recovering perfusion of isch-emic myocardium as early as possible for acute myocardial infarction（AMI）and important for improving clinicalprognosis. This study was aim to analyze platelet function and clinical prognosis during PCI in AMI with ischemicpostconditioning. Method A total of 71 consecutives were enrolled and divided randomly into the control group of34 cases and the observation group of 37 cases. Patients in the observation group received remote ischemic postcon-ditioning. Differences of platelet alpha granule membrane glycoprotein（CD62P）and activated Ⅱb/ⅢA（PAC-1）percentages with flow cytometry before PCI,the moment of PCI intervention,including before and 24,48 h afterPCI,the maximum platelet aggregation rate induced by adenosine diphosphate（ADP） and arachidonic acid（AA）by turbidimetry,rate of major adverse cardiac events（MACE）after 6.0 month follow-up were analyzed.Results The CD62P percentage at 24 h post-PCI in the observation group was significantly lower（P〈0.05）,butno statistical differences were observed during other times.No statistical difference was found in PAC-1 percentagein the two groups during all times.No significant difference in the maximum platelet aggregation rate induced byADP and AA in the two groups was found. While the MACE rate in observation group was significantly lowered（P〈0.05）. Conclusion Remote ischemic postconditioning can reduce the short-term MACE rate for emergentPCI in AMI patients,which may contribute to improving activation degree of platelet CD62P.

关 键 词：急性心肌梗死 远端缺血后适应 经皮冠脉介入治疗 血小板活化 最大聚集率 主要心脏不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]