不同剂量氯吡格雷对冠状动脉粥样硬化性心脏病患者凝血功能及炎症反应的影响  

Effects of different doses of clopidogrel on coagulation function and inflammatory response in patients with coronary atherosclerosis heart disease

作　　者：刘旭辉[1] 钱文浩 方翔[1] 王勇[1] LIU Xuhui;QIAN Wenhao;FANG Xiang;WANG Yong(Department of Geriatric Cardiology,the Second People′s Hospital of Huaian,Huaian 223002,Jiangsu Province,China;Department of Cardiovascular Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]淮安市第二人民医院老年心血管科,江苏淮安223002 [2]徐州医科大学附属医院心血管内科,江苏徐州221000

出　　处：《新乡医学院学报》2020年第4期362-366,共5页Journal of Xinxiang Medical University

基　　金：淮安市自然科学研究计划项目(编号:HAB201817)。

摘　　要：目的探讨不同剂量氯吡格雷对冠状动脉粥样硬化性心脏病患者血小板膜糖蛋白、血小板聚集率及抑制率、凝血功能及炎症因子的影响。方法选择2014年1月至2017年10月于淮安市第二人民医院就诊的96例CAHD患者为研究对象,将患者分为高剂量组(n=50)和常规剂量组(n=46)。2组患者均给予阿司匹林及调脂药物等常规对症治疗措施,在此基础上,常规剂量组患者口服氯吡格雷,首剂300 mg,随后每次75 mg维持治疗,每日1次,治疗7 d;高剂量组患者首剂口服氯吡格雷600 mg,随后每次150 mg维持治疗,每日1次,治疗7 d。采用酶联免疫吸附法测定2组患者治疗前及治疗7 d后血浆血小板活化分子α颗粒膜蛋白(CD62p)、可溶性白细胞分化抗原40配体(s CD40L)水平和血清单核细胞趋化因子-1(MCP-1)水平;流式细胞计数仪检测2组患者治疗前及治疗7 d后血浆溶酶体膜蛋白(CD61)、溶酶体完整膜蛋白(CD63);使用全自动血凝分析仪检测2组患者治疗前及治疗7 d后血浆纤维蛋白原(FIB)水平、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT);采用血小板聚集仪检测2组患者治疗前及用药24 h后血小板聚集率和血小板抑制率;免疫散射比浊法检测2组患者治疗前和治疗7 d后血清高敏C反应蛋白(hs-CRP)水平。结果治疗前2组患者血小板膜糖蛋白CD61、CD63比率及血浆CD62p、s CD40L水平、血小板聚集率、血小板抑制率、FIB、APTT、PT、TT、血清MCP-1和hs-CRP水平比较差异均无统计学意义(P>0.05)。2组患者治疗7 d后CD61、CD63比率及血浆CD62p、FIB水平、血清MCP-1、hs-CRP水平均显著低于治疗前(P<0.05);2组患者治疗7 d后血浆s CD40L水平及APTT、PT、TT与治疗前比较差异均无统计学意义(P>0.05)。治疗7 d后,高剂量组患者CD61、CD63比率及血浆CD62p、FIB水平和血清MCP-1、hs-CRP水平均显著低于常规剂量组(P<0.05);2组患者血浆s CD40L水平比较差异无统Objective To investigate the effects of different doses of clopidogrel loads on platelet membrane glycoprotein,platelet aggregation rate and inhibition rate,coagulation function and inflammatory factors in patients with coronary atherosclerosis heart disease(CAHD).Methods Ninty-six CAHD patients in the Second People’s Hospital of Huaian from January2014 to October 2017 were selected as the study objects.The patients were divided into high dose group(n=50)and conventional dose group(n=46).All patients were given aspirin,lipid-regulating drugs and other conventional symptomatic treatment measures.Based on this,the patients in the conventional dose group took the clopidogrel orally,the first dose was 300 mg per day,followed by 75 mg per day maintenance treatment,once a day for 7 days;the patients in the high-dose group took orally clopidogrel 600 mg for the first dose,followed by 150 mg maintenance treatment,once a day for 7 days.The levels of platelet membrane glycoprotein ofαgrana membrane protein(CD62p),soluble CD40 ligand(sCD40L)and serum monocyte chemokine-1(MCP-1)of patients in the two groups were measured by enzyme-linked immunosorbent assay before and 7 days after treatment;the plasma lysosomal membrane protein(CD61),lysosomal integral membrane protein(CD63)of patients in the two groups were measured by flow cytometer before and 7 days after treatment;the plasma fibrinogen(FIB),activated partial prothrombin time(APTT),prothrombin time(PT)and blood enzyme(TT)of patients in the two groups were measured by the automatic hemagglutination analyzer before and 7 days after treatment;the platelet aggregation rate,platelet inhibition rate of patients in the two groups were measured by the platelet aggregation instruments before and 24 hours after taking medicine;the serum high-sensitivity C-reactive protein(hs-CRP)level of patients in the two groups were measured by the immune scattering turbidimetry.Results There was no significant difference in the platelet membrane glycoprotein CD61,CD63 ratio,the levels of pla

关 键 词：氯吡格雷 冠状动脉粥样硬化性心脏病 凝血功能 炎症因子 

分 类 号：R541.4[医药卫生—心血管疾病]