冠心病患者血小板聚集功能与疾病严重程度及生化指标关系的研究
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摘要
目的探讨冠心病患者血小板聚集功能在不同临床分型、不同冠脉病变支数水平变化及与同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)相关性。方法回顾性分析唐山市第三医院首次确诊的冠心病患者152例,按照冠状动脉造影结果将冠心病患者分为单支病变组和多支病变组;再按应激状态分为急性冠脉综合征(ACS)组和非ACS组,分析以二磷酸腺苷(ADP)和花生四烯酸(AA)为诱导剂的血小板聚集功能在各组间的变化,探讨其与Hcy、hs-CRP的相关性。结果单支病变组和多支病变组以ADP和AA为诱导剂的最大血小板聚集率比较差异均无统计学意义(P>0.05);ACS组与非ACS组以ADP和AA为诱导剂的最大血小板聚集率比较差异均有统计学意义(P<0.05);冠心病患者hs-CRP、Hcy水平与AA、ADP诱导的最大血小板聚集率呈显著的正相关(r1=0.29、0.33;r2=0.37、0.34,P<0.05)。结论最大血小板聚集率在ACS、非ACS患者中呈现不同的变化且与hs-CRP、Hcy密切相关,对冠心病的诊断、治疗、危险评估有一定的参考价值。
Objective To investigate the relationship among platelet aggregation function in patients with coronary heart disease(CHD)in different clinical types,changes in the coronary branch number and risk factors such as homocysteine(Hcy)and hypersensitive C-reactive protein(hs-CRP).Methods Retrospective analysis of 152 patients with coronary heart disease diagnosed for the first time in Tangshan No.3 Hospital.The selected coronary heart disease patients were divided into single branch and multiple branch lesions according to the results of coronary angiography.In addition,according to the stress state,it was divided into acute coronary syndrome(ACS)and non-acute coronary syndrome(non-ACS)groups.The platelet aggregation function of adenosine diphosphate(ADP)and arachidonic acid(AA)as inducers was analyzed to compare difference between groups.To investigate the correlation among the platelet aggregation function,Hcy and hsCRP.Results There was no significant difference in the maximum platelet aggregation rate of adenosine ADP and AA in single branch lesions group and multiple branch lesions group(P>0.05);The difference in the maximum platelet aggregation between the acute coronary syndrome group and the non-acute coronary syndrome group ADP and AA was statistically significant(P<0.05);hs-CRP and Hcy levels were positively correlated with the maximum platelet aggregation rate induced by AA and ADP(r1=0.29,0.33;r2=0.37,0.34,P<0.05).Conclusion The maximum platelet aggregation rate in ACS,non-ACS showed different changes,which is closely related to hs-CRP and Hcy.It may be of reference value for diagnosis,treatment and risk assessment of coronary heart disease.
Objective To investigate the relationship among platelet aggregation function in patients with coronary heart disease(CHD)in different clinical types,changes in the coronary branch number and risk factors such as homocysteine(Hcy)and hypersensitive C-reactive protein(hs-CRP).Methods Retrospective analysis of 152 patients with coronary heart disease diagnosed for the first time in Tangshan No.3 Hospital.The selected coronary heart disease patients were divided into single branch and multiple branch lesions according to the results of coronary angiography.In addition,according to the stress state,it was divided into acute coronary syndrome(ACS)and non-acute coronary syndrome(non-ACS)groups.The platelet aggregation function of adenosine diphosphate(ADP)and arachidonic acid(AA)as inducers was analyzed to compare difference between groups.To investigate the correlation among the platelet aggregation function,Hcy and hsCRP.Results There was no significant difference in the maximum platelet aggregation rate of adenosine ADP and AA in single branch lesions group and multiple branch lesions group(P>0.05);The difference in the maximum platelet aggregation between the acute coronary syndrome group and the non-acute coronary syndrome group ADP and AA was statistically significant(P<0.05);hs-CRP and Hcy levels were positively correlated with the maximum platelet aggregation rate induced by AA and ADP(r1=0.29,0.33;r2=0.37,0.34,P<0.05).Conclusion The maximum platelet aggregation rate in ACS,non-ACS showed different changes,which is closely related to hs-CRP and Hcy.It may be of reference value for diagnosis,treatment and risk assessment of coronary heart disease.
引文
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[11]刘春兴,闵贤,潘杰.中年自然人颈动脉粥样硬化斑块与血清hs-CRP、HCY水平的相关研究[J].中国医药导刊,2012,14(5):853-854.
[12]LIU J,QUAN J,LI Y,et al.Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome:A STROBE-compliant observational study[J].Medicine(Baltimore),2018,97(40):e12626.
[13]孔繁亮,陈小艳,陈缙,等.同型半胱氨酸引起血小板聚集率升高对心血管疾病的影响[J].广东医学,2016,37(13):1948-1951.
[14]张丽晖,代文娟,任方刚,等.急性冠脉综合征与血小板聚集率变化的临床研究[J].中西医结合心脑血管病杂志,2015,13(12):1418-1421.
[15]DUC C N,DUNG H T.The risk factors of acute coronary syndrome in patients over 65years old at Thong Nhat Hospital of Ho Chi Minh city Vietnam[J].J Atheroscler Thromb,2014,21(Suppl 1):S36-41.
[16]齐新,刘克强,王敏,等.冠心病患者血小板聚集功能与炎症因子关系的研究[J].中国循环杂志,2009,24(3):178-181.
[17]李方江,王晓元,张文婷,等.急性冠脉综合征患者血清炎症标记物IL-6R及ADAMTS-1的研究[J].中国实验诊断学,2014,18(9):1479-1480.
[18]张云平,王丽艳,赵宇,等.冠心病患者同型半胱氨酸水平与血小板聚集功能的相关性探讨[J].中国血液流变学杂志,2013,23(3):535-537.
[19]JIN L,YU H,DONG T,et al.The prognostic value of ADP-induced platelet aggregation for bleeding complications in low intermediate risk patients with acute coronary syndrome taking clopidogrel after percutaneous coronary intervention[J].Heart Lung Circ,2017,26(1):49-57.
[2]齐宏,黄珊,马祥生,等.同型半胱氨酸、高敏C反应蛋白及胱抑素C和脂蛋白相关磷脂酶A2与冠心病的相关性[J].广东医学,2014,35(14):2253-2256.
[3]KANDER J,BROKOPP J,ERLINGR D,et al.Temperature effects on haemostasis in whole blood from ticagrelor and aspirin treated patients with acute coronary syndrome[J].Scand J Clin Lab invest,2015,75(1):27-35.
[4]GURBEL P A,BECKER R C,MANN K G,et al.Platelet function monitoring in patients with coronary artery disease[J].J Am Coll Cardiol,2007,50(19):1822-1834.
[5]周永列,张继业.血小板活化标志物及其临床意义[J].国外医学:临床生物化学与检验学分册,2000,21(6):299-301.
[6]CHOSHAL K,BHATTACHARYYA M.Overview of platelet physiology:its hemostatic and non hemostatic role in disease pathogenesis[J].Sci Word J,2014,20(14):781787.
[7]ASLAN J E,BAKER S M,LOREN C P,et al.The PAKsystem links Rho GTP ase signaling to theombin-mediated platelet activation[J].Am J Physiol Cell Physiol,2013,305(5):519-528.
[8]DIAGOURAGA B,GRICHINE A,FERTIN A,et al.Motor-driven marginal band coiling promotes cell shape change during platelet activation[J].J Cell Biol,2014,204(2):177-185.
[9]SANTOS-MARTINEZ M J,PRIAN-MELLO A,MEDI-NA C,et al.Analysis of platelet function:role of microfluidics and nanodevices[J].Analyst 2011,136(24):5120-5126.
[10]HASSAN A,DOHI T,MIYANCHI K,et al.Prognostic impact of homocysteine levels and homocysteine thiolactonase activity on long-term clinical outcomes in patients undergoing percutaneous coronary intervention[J].J Cardiol,2017,69(6):830-835.
[11]刘春兴,闵贤,潘杰.中年自然人颈动脉粥样硬化斑块与血清hs-CRP、HCY水平的相关研究[J].中国医药导刊,2012,14(5):853-854.
[12]LIU J,QUAN J,LI Y,et al.Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome:A STROBE-compliant observational study[J].Medicine(Baltimore),2018,97(40):e12626.
[13]孔繁亮,陈小艳,陈缙,等.同型半胱氨酸引起血小板聚集率升高对心血管疾病的影响[J].广东医学,2016,37(13):1948-1951.
[14]张丽晖,代文娟,任方刚,等.急性冠脉综合征与血小板聚集率变化的临床研究[J].中西医结合心脑血管病杂志,2015,13(12):1418-1421.
[15]DUC C N,DUNG H T.The risk factors of acute coronary syndrome in patients over 65years old at Thong Nhat Hospital of Ho Chi Minh city Vietnam[J].J Atheroscler Thromb,2014,21(Suppl 1):S36-41.
[16]齐新,刘克强,王敏,等.冠心病患者血小板聚集功能与炎症因子关系的研究[J].中国循环杂志,2009,24(3):178-181.
[17]李方江,王晓元,张文婷,等.急性冠脉综合征患者血清炎症标记物IL-6R及ADAMTS-1的研究[J].中国实验诊断学,2014,18(9):1479-1480.
[18]张云平,王丽艳,赵宇,等.冠心病患者同型半胱氨酸水平与血小板聚集功能的相关性探讨[J].中国血液流变学杂志,2013,23(3):535-537.
[19]JIN L,YU H,DONG T,et al.The prognostic value of ADP-induced platelet aggregation for bleeding complications in low intermediate risk patients with acute coronary syndrome taking clopidogrel after percutaneous coronary intervention[J].Heart Lung Circ,2017,26(1):49-57.