炎症反应对急性冠脉综合征患者血小板活性及预后的影响

目的:观察急性冠脉综合征(ACS)患者炎症反应与血小板活性的关系及对预后的影响。方法:348例ACS患者根据是否合并全身炎症反应综合征(SIRS)分为SIRS组(n=128)及对照组(n=220)。两组均给予标准的冠心病二级预防及冠状动脉介入(PCI)治疗。比较两组患者术前血小板最大聚集率(mPAR)、超敏C反应蛋白(hs-CRP)、血清可溶性CD40L(sCD40L)、血清基质金属蛋白酶-9(MMP-9)等指标的差异,分析两组各种炎症因子水平与mPAR的相关性,并比较术后30天两组不良事件的发生率。结果:SIRS组患者mPAR、hs-CRP、sCD40L、MMP-9均明显高于对照组(P均<0.01);两组hs-CRP、sCD40L、MMP-9水平与mPAR之间均呈正相关(P<0.01)。术后30天,SIRS组患者不良事件发生率高于对照组(P<0.01)。结论:炎症反应可能是导致血小板活化的原因之一,合并SIRS的ACS患者预后较差。

Influence of Inflammatory Response to Platelet Activity and Prognosis in Patients with Acute Coronary Syndrome

Objective: To observe the association of inflammatory response with platelet activity and its influence to prognosis in patients with acute coronary syndrome(ACS). Method: A total of 348 patients were assigned to two groups according to systemic inflammatory response syndrome(SIRS): SIRS group (n=128) and control group (n=220).Two groups accepted standard secondary prevention therapy of coronary heart diseases and percutaneous coronary intervention (PCI). To compare the differences of the maximum platelet aggregation rates (mPAR) using adenosine diphosphate (ADP), high sensitive C reaction protein (hs-CRP), soluble cluster differentiation 40 ligand (sCD40L), matrix metalloproteinase-9 (MMP-9). To analyze the association of platelet activity and inflammatory factors. The clinical endpoint cases were monitored within 30 days after PCI in two groups. Results: At pre-stenting, The mPAR,hs-CRP,sCD40L,MMP-9 in SIRS group were significantly higher than control group(P<0.01).There were positive straight lines correlations between platelet function and inflammatory response factors in two groups(P<0.01). The incidence rate of clinical endpoint event in SIRS group was significantly higher than the control group at 30 days after PCI(P<0.01). Conclusion: Inflammatory response maybe is a factor of causing platelet activity. The patients with SIRS and ACS have a worse prognosis.