冠状动脉介入治疗后应用氯吡格雷治疗的患者血小板活化情况
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摘要
目的探讨冠状动脉介入治疗(PCI)后,患者应用氯吡格雷作为抗血小板药物口服治疗,观察血小板活化的变化情况。方法采用流式细胞术(FCM)分别对PCI患者和健康体检人群血小板GPⅡb/Ⅲa进行检测,同时观察PCI患者应用氯吡格雷治疗前、后血小板GPⅡb/Ⅲa水平的变化。结果实验组入选时与健康对照组进行比较,实验组入选时GPⅡb/Ⅲa的水平较健康对照组明显升高,两组血小板GPⅡb/Ⅲa水平差异有统计学意义(P<0.05)。用药7d后其GPⅡb/Ⅲa水平较入选时明显下降,两组血小板GPⅡb/Ⅲa水平差异有统计学意义(P<0.05)。而健康对照组与实验组用药7d后进行比较,两组血小板GPⅡb/Ⅲa水平差异无统计学意义(P>0.05)。结论 PCI后应用氯吡格雷治疗患者血小板活化水平大部分都有明显下降,但仍有少部分患者没有明显下降,推测可能与血小板抵抗有关。
Objective To observe the platelet activation changes in patients with clopidogrel therapy after percutaneous coronary intervention(PCI).Methods Platelet GPⅡb/Ⅲa level was analyzed in patients before and after undergoing PCI with clopidogrel therapy and healthy controls by using flow cytometry.Results The GPⅡb/Ⅲa level was dramatically promoted in experiment group before clopidogrel therapy than that in control group(P<0.05),but there was no statistical difference after 7 days after clopidogrel therapy(P>0.05).Conclusion After receiving PCI,the platelet activation level might be significantly higher than that in healthy subjects(P<0.05).Therapy of clopidogrel could reducing the platelet activation level in patients receiving PCI,but there were still 10.71% of patients without significant decreasing(P>0.05),which might be related with platelet resistance.
Objective To observe the platelet activation changes in patients with clopidogrel therapy after percutaneous coronary intervention(PCI).Methods Platelet GPⅡb/Ⅲa level was analyzed in patients before and after undergoing PCI with clopidogrel therapy and healthy controls by using flow cytometry.Results The GPⅡb/Ⅲa level was dramatically promoted in experiment group before clopidogrel therapy than that in control group(P<0.05),but there was no statistical difference after 7 days after clopidogrel therapy(P>0.05).Conclusion After receiving PCI,the platelet activation level might be significantly higher than that in healthy subjects(P<0.05).Therapy of clopidogrel could reducing the platelet activation level in patients receiving PCI,but there were still 10.71% of patients without significant decreasing(P>0.05),which might be related with platelet resistance.
引文
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[13]Geiger J,Teichmann L,Grossmann R,et al.Monitoring ofClopidogrelAc2tion:Comparison of Methods[J].ClinChem,2005,51(6):957-965.
[14]Harrison P,Frelinger AL 3rd,Furman MI,et al.Measur-ing antiplatelet drug effects in the laboratory[J].ThrombRes,2007,120(3):323-326.
[15]刘彦虹,安晶红.脑血栓与血小板活化关系的研究[J].中国实验诊断学,2008,12(2):220-221.
[16]陈颖,金文君.流式细胞术检测活化血小板在脑梗死诊治中的应用[J].浙江预防医学,2009,21(2):79-80.
[2]郭朝阳.国产氯吡格雷在急性心肌梗死急诊冠状动脉内介入治疗中的临床观察[J].中国实用医药,2011,6(22):164-165.
[3]白如冰,贾绍斌.冠状动脉介入术后血小板活化的意义[J].宁夏医学杂志,2003,25(8):509-511.
[4]Plsker GL,Lyeng-Willianson KA.Clopidogrel:a review ofits use in the prevention of thrombosis[J].Drugs,2007,67(4):613-646.
[5]刘继文,程晓曙,杨人强,等.急性冠脉综合征患者抗血小板药物疗效和对氯吡格雷的反应性[J].中国循环杂志,2008,23(3):189-192.
[6]Deibele AJ,J ennings LK,Tcheng JE,et al.Intracoronaryeptifibatide bolus administration during percutaneous co-ro2nary revascularization for acute coronary syndromeswith e2valuation of platelet glycoproteinⅡb/Ⅲa recep-tor occupancy and platelet function:the Intraecronary Ep-tifibatide(ICE)Trial[J].Circulation,2010,121(6):784-791.
[7]Belvis R,Pagonabarraga J,Santamaria A,et al.Clopi-dogrel in secondary ischemic stoke prevention[J].RecentPat Cardiovasc Drug Discov,2008,3(2):119-125.
[8]林运灵,陈良龙.氯吡格雷抵抗研究现状[J].心血管病学进展,2007,28(4):550-554.
[9]汤洪顺.氯吡格雷抵抗的研究进展[J].(下转第1079页)现代诊断与治疗,2010,21(6):349-352.
[10]孔祥姣,陶贵周.氯吡格雷抵抗研究进展[J].临床误诊误治,2009,22(5):78-79.
[11]苑磊,张代富.氯吡格雷抵抗的研究进展[J].医药导报,2010,29(12):1607-1610.
[12]黎庆梅,韦建瑞,洪介民,等.流式细胞术检测血小板活化的影响因素分析[J].中国病理生理杂志,2009,25(3):510-512.
[13]Geiger J,Teichmann L,Grossmann R,et al.Monitoring ofClopidogrelAc2tion:Comparison of Methods[J].ClinChem,2005,51(6):957-965.
[14]Harrison P,Frelinger AL 3rd,Furman MI,et al.Measur-ing antiplatelet drug effects in the laboratory[J].ThrombRes,2007,120(3):323-326.
[15]刘彦虹,安晶红.脑血栓与血小板活化关系的研究[J].中国实验诊断学,2008,12(2):220-221.
[16]陈颖,金文君.流式细胞术检测活化血小板在脑梗死诊治中的应用[J].浙江预防医学,2009,21(2):79-80.