抗血小板药物对脑梗死患者血小板-白细胞聚集体的影响

目的观察急性脑梗死患者血小板一白细胞聚集体（PLA）的变化以及阿司匹林和氯吡格雷对其的影响。方法对急性脑梗死和对照组患者血小板聚集率（PAR）、可溶性P选择素（sP—sel）、C-反应蛋白（CRP）和PLA进行检测。同时将急性脑梗死患者随机分为阿司匹林组和氯吡格雷组,观察两组患者治疗前后斯堪的纳维亚神经卒中量表（SNSS）评分、PAR、sP—sel、CRP和PLA的变化。结果急性脑梗死患者血小板单核细胞聚集体（PMA）显著高于对照组（P〈0．001）;PMA水平与PAR、sP-sel、CRP、血糖、胆固醇和纤维蛋白原正相关（P〈0．05）;与SNSS评分负相关（P〈0．05）。脑梗死患者治疗后PMA、PAR明显下降（P≤0．001）,且治疗后氯吡格雷组PMA和PAR（ADP）降低较阿司匹林组更明显（P〈0．05）,但PAR（AA）两组间差异无统计学意义;sP-sel在氯吡格雷组治疗后显著下降（P〈0．001）。结论急性脑梗死患者反映血小板活化的敏感指标PMA明显增高,阿司匹林和氯吡格雷可以降低PMA水平,其中氯吡格雷作用较阿司匹林更为明显。

The changes and effects of antiplatelet agents on platelet-leukocyte aggregation in patients with acute cerebral infarction

OBJECTIVE: To investigate the changes of platelet-leukocyte aggregation (PLA) in patients with cerebral infarction and the effects of antiplatelet agents on it. METHODS: The levels of plasma soluble P-selectin (sP-sel), serum C-reactive protein (CRP), platelet aggregation rate (PAR) and PLA were measured in 40 patients with acute cerebral infarction and 20 cases of controls. The 40 patients with cerebral infarction were randomly divided into aspirin-treated group (20 cases) and clopidogrel-treated group (20 cases) scandinavian neurological sroke score (SNSS), plasma sP-sel, serum CRP, PAR and PLA were observed before and after the treatment. RESULTS: Compared with controls, the percentage of monocyte-platelet aggregation (PMA) was significantly increased in the patients (P < 0.001). The level of plasma sP-sel, serum CRP and PAR in the case group were significantly greater than those in the control group (P < 0.05). The level of PMA was positively related with the plasma sP-sel, serum CRP and PAR in cerebral infarction patients before treatment (P < 0.05), and it showed a significant inverse correlation between the percentage of PMA and the score of SNSS (P < 0.05). After treatment, the levels of PMA and PAR were decreased in both groups of cerebral infarction patients (P < or = 0.001), and the level of PMA and PAR (ADP) in clopidogrel-treated group was lower than those in aspirin-treated group (P < 0.05). However, the CRP in the patients was no significant difference before and after treatment. The level of sP-sel was no significant difference before and after treatment in aspirin-treated group, but it was significantly decreased after treatment in clopidogrel-treated group (P < 0.001). CONCLUSIONS: The levels of PMA in patients with cerebral infarction was significantly higher than in the controls. PMA may be a sensitive marker of platelet activation. Aspirin and Clopidogrel could decline the level of PMA in the patients with actue cerebral infarction, and Clopidogrel was more effective than aspirin in inhibiting the activation of platelet.