老年急性冠状动脉综合征患者血小板P选择素、血管性血友病因子的变化及氯吡格雷干预的临床研究

目的观察老年急性冠状动脉综合征(ACS)患者血小板P选择素和血管性血友病因子(vWF)的变化,及抗血小板聚集药物氯吡格雷干预后的临床相关研究,探讨它们在ACS发病机制中的作用和相互联系。方法选取60例老年ACS患者,其中急性心肌梗死(AMI)患者30例,不稳定型心绞痛(UAP)患者30例,另设对照组30例。随机将UAP分为常规治疗组和氯吡格雷(75mg/d)组,AMI组应用抗血小板聚集药物(氯吡格雷300mg+阿司匹林)联合治疗,采用全血法流式细胞术及血浆酶联免疫吸附法测定各组治疗前后血小板P选择素、vWF水平变化,同时探讨P选择素与vWF的相关关系。结果老年ACS患者P选择素、vWF水平[AMI组P选择素(9.74±1.97)%,vWF(272.24±28.62)%;UAP组P选择素(8.87±1.78)%,vWF(215.81±22.01)%]显著高于正常对照组[P选择素(2.27±1.30)%,vWF(112.45±13.22)%](P<0.001)。常规治疗组和氯吡格雷组均可降低UAP患者P选择素与vWF水平[常规治疗组P选择素治疗前(8.60±1.39)%,治疗后(5.60±2.18)%,降低(2.97±1.82)%,vWF治疗前(217.52±25.68)%,治疗后(170.17±20.88)%,降低(47.34±24.31)%;氯吡格雷组P选择素治疗前(9.15±2.11)%,治疗后(4.24±1.73)%,降低(4.89±2.02)%,vWF治疗前(214.10±18.35)%,治疗后(151.72±12.66)%,降低(62.38±21.58)%],但氯吡格雷组较常规治疗组降低的程度更明显(P<0.05),AMI组联合治疗后P选择素与vWF水平均低于治疗前[P选择素(2.27±1.30)%,vWF(112.45±13.22)%](P<0.001),但仍高于对照组(P<0.001)。老年ACS患者P选择素水平与vWF水平成正相关(r=0.365,P<0.05)。结论P选择素、vWF与ACS的发病过程有关,可能是老年ACS不稳定斑块的识别和预测指标。

Clinical study of platelet p-selectin and von willebrand factor before and after clopidogrel therapy in elderly patients with acute coronary syndrome

Objective To investigate the changes of platelet P-selectin and von willebrand factor (vWF) before and after clopidogrel therapy in elderly patients with acute coronary syndrome (ACS). Methods The expression of activated P-selectin on platelet and the plasma level of vWF were assayed by flow cytometry or enzyme linked immunosorbent assay (ELISA) in 60 elderly patients with ACS (30 acute myocardial infarction (AMI) and 30 unstable angina pectoris (UAP) and 30 healthy controls. UAP patients were randomly divided into two groups: 15 patients received clopidogrel(75 mg/d) plus aspirin (clopidogrel group) and 15 patients received only aspirin (routine therapy group); All AMI patients all received combined therapy: clopidogrel (300 mg)plus Aspirin. The correlation between P-selectin and vWF was also analyzed. Results P-selectin and vWF levels in elderly ACS patients were significantly higher than in healthy control group (both P<0.001). P-selectin and vWF were decreased in both clopidorel group and routine therapy group in UAP patients with a more significant decrease in clopidogrel group (P<0.05). Combined therapy quickly inhibited P-selectin and vWF in AMI patients (P<0.001). There was a positive correlation between the P-selectin and the vWF level (r=0.365, P=0.004). Conclusions P-selectin and vWF are related to the pathogenesis of ACS and can be predictors for ACS. Clopidogrel may improve prognosis in elderly ACS by inhibiting platelet activation and protecting endothelium.