摘要
目的:检测急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)术前后血浆中血栓素蛋白1(TSP-1)水平,分析其与不稳定斑块、血小板水平的相关性。方法:酶联免疫吸附实验检测24例急性ST段抬高型心肌梗死患者(A组)、20例慢性稳定型冠心病患者(B组)、20名冠脉造影正常的对照者(C组)的血液标本中TSP-1水平。AMI患者均按照指南规范服用阿司匹林、氯吡格雷。结果:3组基线临床特征在性别、年龄、风险因素及服用药物方面无统计学差异,具有可比性。研究对象入院时A组CRP、IL-6水平均高于C组,P<0.01,支持A组冠脉血管斑块处于不稳定阶段;入院时A组TSP-1水平(312±160)ng/L,高于B组及C组,P<0.05。术前准备阶段服用阿司匹林和氯吡格雷后,TSP-1水平升高,3组较入院时分别增加(14±10)%,(22±15)%,(17±10)%,组间比较无统计学差异。PCI术或冠脉造影术后TSP-1水平变化显著,3组较入院时分别增加(55±21)%,(61±25)%,(56±19)%,均为P<0.01,与入院时比较有显著性差异,提示PCI或冠脉造影术明显促进TSP-1释放。结论:急性ST段抬高型心肌梗死时TSP-1、CRP、IL-6水平均明显高于稳定冠心病组及对照组,TSP-1升高与不稳定斑块密切相关。阿司匹林和氯比格雷药物抑制血小板活化,增加TSP-1表达;PCI术后TSP-1表达显著增加,初步分析与PCI术操作本身、术中应用肝素钠针以及替罗非班等有关。
Objective：To detect the plasma thrombospondin-1 （TSP-1） changes in patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）,and the study the relationship between TSP-1 and unstable plaque and platelet count. Methods：Sixty-four subjects were divided into acute ST-segment elevation myocardial infarction group （Group A,n=24）,chronic stable angina group （Group B,n=20）,and normal selective coronary angiography （SCA） control group （Group C,n=20）. All AMI patients were taking aspirin and clopidogrel according to the guidelines,then the contents of TSP-1 pre-and post-PCI were detected,and the relationship between the contents of TSP-1,inflammatory factors,and the stability of plaque was analyzed. Results：Compared with those in Group B or C,the contents of CRP and IL-6 were higher in group A respectively. The levels of TSP-1 in group A was higher than in group C （P〈1.05）. After the treatment of aspirin and clopidogrel before PCI,the levels of TSP-1 were increased by （14%±10%）,（22%±15%）,and （17%±10%） respectively in group A,B,and C; while after PCI or coronary angiography,the levels of TSP-1 were increased by （55%±21%）,（61%±25%）,and （56%±19%）,P〈1.01. Conclusion：There existed certain relationship between the contents of TSP-1,CRP,IL-6,and unstable plaque. The drugs such as aspirin and clopidogrel can inhibit the activation of platelet and increase the expression of TSP-1. The serum levels of TSP-1 increase significantly in the AMI patients after treatment with emergency PCI,and it indicates that PCI could stimulate the release of TSP-1.
出处
《武汉大学学报（医学版）》
CAS
北大核心
2009年第6期763-766,共4页
Medical Journal of Wuhan University
关键词
急性心肌梗死
血栓素蛋白1
不稳定斑块
炎症因子
Acute Myocardial Infaretion
Thrombospondin-1
Unstable Plaque
Inflammatory Cytokine
