中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (39): 7285-7290.doi: 10.3969/j.issn.1673-8225.2010.39.016

• 骨科植入物 orthopedic implant • 上一篇    下一篇

支架置入非ST段抬高急性冠脉综合征患者血小板功能及替罗非班的干预

梁海峰1，杨  明1，崔建英2，韩  凌1，高  亢1，赵  燕1，陈  萍1   

  1. 首都医科大学附属复兴医院，1心脏中心，2内科实验室，北京市 100038
  • 出版日期:2010-09-24 发布日期:2010-09-24
  • 通讯作者: 杨明，博士，教授，主任医师，硕士生导师，首都医科大学附属复兴医院心脏中心，北京市 100038
  • 作者简介:梁海峰★，男，1975年生，河北省万全县人，汉族，首都医科大学毕业，硕士，副主任医师，主要从事急性冠脉综合征的研究。 Lianghaifeng_dty@126.com

Platelet function and tirofiban treatment in patients with non-ST-segment elevation acute coronary syndromes following stenting

Liang Hai-feng1, Yang Ming1, Cui Jian-ying2, Han Ling1, Gao Kang1, Zhao Yan1, Chen Ping1   

  1. 1 Cardiology Center, 2 Laboratory of Internal Medicine, Fuxing Hospital of Capital Medical University, Beijing  100038, China
  • Online:2010-09-24 Published:2010-09-24
  • Contact: Yang Ming, Doctor, Professor, Chief physician, Cardiology Center, Fuxing Hospital of Capital Medical University, Beijing 100038, China
  • About author:Liang Hai-feng★, Master, Associate chief physician, Cardiology Center, Fuxing Hospital of Capital Medical University, Beijing 100038, China Lianghaifeng_dty@126.com

PDF

426

被引次数

5

摘要：

背景：目前，经皮冠状动脉介入围手术期如何给予个体化的抗血小板治疗国内外尚没有达成共识；在抗血小板的联合用药、用药时机和应用时间方面也存在着较多的争议。
目的：观察非ST段抬高急性冠脉综合征患者支架置入前后血小板活性的变化及替罗非班的干预作用。
方法：125例患者随机分为2组：替罗非班组(n=62)：阿司匹林+氯吡格雷+替罗非班；对照组(n=63)：阿司匹林+氯吡格雷；两组均行经皮冠状动脉介入治疗，观察支架置入前及置入后6，24 h及7 d，经花生四烯酸诱导的血小板最大聚集率、血小板活化标志物CD62p变化；两组患者经皮冠状动脉介入治疗后30 d临床事件及出血事件的发生率。
结果与结论：支架置入后6 h，对照组血小板最大聚集率及CD62p水平较置入前显著升高(P < 0.01)；替罗非班组则显著低于置入前及对照组(P < 0.01)；置入后24 h，两组之间及与置入前相比，血小板最大聚集率及CD62p差异无显著性意义(P > 0.05)；置入后7 d，替罗非班组血小板最大聚集率较置入前降低(P < 0.05)。替罗非班组经皮冠状动脉介入治疗后30 d临床缺血事件的发生率低于对照组(P < 0.05)；两组患者出血事件发生率差异无显著性意义(P > 0.05)。提示支架置入后6 h，非ST段抬高急性冠脉综合征患者血小板功能被进一步激活。在双重抗血小板(阿司匹林+氯吡格雷)治疗的基础上，替罗非班对接受支架置入非ST段抬高急性冠脉综合征患者的血小板功能有进一步的抑制作用。

关键词: 急性冠脉综合征, 经皮冠状动脉介入治疗, 药物洗脱支架, 替罗非班, 血小板最大聚集率

Abstract:

BACKGROUND: Individualized anti platelet therapy remains controversial in perioperative period of percutaneous coronary intervention (PCI). Moreover, the combination administration for anti platelet, administration time and duration are poorly understood.
OBJECTIVE: To test the influence of stent planting on the platelet activation in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and the effects of tirofiban.
METHODS: A total of 125 patients were randomly assigned to two groups: tirofiban (n=62): clopidogrel +aspirin+ tirofiban; control group (n=63): clopidogrel +aspirin. Both groups were treated with PCI. The maximum platelet aggregation rates (mPAR) induced by arachidonic acid (AA), platelet activation marker CD62p were measured before and 6, 24, hours and 7 days post-stenting. Moreover, clinical endpoint cases were monitored within 30 days after PCI.
RESULTS AND CONCLUSION: After PCI 6 hours, mPAR and CD62p were reduced significantly in tirofiban group compared with pre-PCI operation and control group (P < 0.01) and that in control group were significantly higher than pre-PCI (P < 0.01). No significant differences were observed in the mPAR and the CD62p in two groups at post-PCI 24 hours (P > 0.05). After PCI 7 days, mPAR was reduced in tirofiban group compared with pre-PCI operation (P < 0.05). The incidence of clinical ischemic event in tirofiban group was significantly lower than the control group after PCI 30 days (P < 0.05), but no significant differences were detected in clinical bleeding event (P > 0.05). After PCI 6 hours, the platelet function is activated. On the basis of double anti-platelet treatment (clopidogrel +aspirin), the platelet function is further inhibited by tirofiban in patients with NSTE-ACS after PCI.

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