替罗非班对急性冠脉综合征患者围手术期血小板和C反应蛋白的影响

目的观察替罗非班对接受双重抗血小板治疗（阿司匹林＋氯吡格雷）的不稳定型心绞痛、非ST段抬高心肌梗死（NSTE-ACS）患者，经皮冠状动脉介入治疗（PCI）围手术期血小板最大聚集率（mPAR）和高敏C反应蛋白（hs-CRP）的影响，探讨两者的相关性。方法125例行择期PCI的高危NSTE-ACS患者随机分为阿司匹林＋氯吡格雷＋替罗非班组（简称替罗非班组）、阿司匹林＋氯吡格雷组（对照组）。替罗非班组患者在PCI前直接冠脉内弹丸式注射替罗非班10μg／k，时间不少于3min，随后以0．15μg／（kg·min）^-1持续泵点8h。检测两组患者PCI围手术期不同时间点mPAR及hs-CRP并分析两者的相关性。结果术前，替罗非班组与对照组mPAR、hs-CRP无统计学差异。术后6h，替罗非班组mPAR、hs—CRP低于术前及对照组；对照组mPAR较术前显著升高，hs—CRP虽较术前轻度升高，但无统计学差异。术后24h及术后7d，两组之间mPAR及hs-CRP无统计学差异。替罗非班组PCI围手术期不同时间点hs—CRP对数值与mPAR呈直线相关。术前及术后24h，对照组hs-CRP对数值与mPAR呈直线相关。术后6h及术后7d，对照组未见相关关系。结论PCI术后6h，在双重抗血小板治疗的基础上，替罗非班对接受PCI术的NSTE-ACS患者的血小板功能和炎症反应有抑制作用；mPAR与hs-CRP呈正相关，hs—CRP对血小板的聚集状态有一定的预测价值。

Influence of Tirofiban on the Platelet and C-reactive Protein in Patients with Acute Coronary Syndromes in Perioperative Period

Objective To test the influence of tirofiban on the platelet activation and high-sensitivity C-reactive protein （hs-CRP） in patients with unstable angina pectoris and non-ST-segment elevation myocardial infarction （NSTE-ACS） after percutaneous coronary intervention （PCI） receiving dual anti-platelet （ aspirin ＋ clopidogrel） therapy. Moreover, the correlation of between hs-CRP and mPAR is assessed during follow-up. Methods 125 patients with NSTE -ACS were randomly divided into two groups： dual anti-platelet therapy ＋ tirofiban versus receiving dual anti-platelet therapy. In tirofiban group, 10μg/kg tirofiban was injected into coronary artery in each patient. The time was not shorter than 3 minutes. And then 0.15μg/kg. min tirofiban was pumped into venous for 8 hours. The mPAR and hs-CRP were measured at different time points in perioperative period. A correlation analysis was performed between mPAR and hs-CRP. Results The mPAR and the hs-CRP in pre-PCI operation of two groups had no significant differences. 6 hours after PCI, the mPAR and the hs-CRP were reduced in tirofiban group compared with pre-PCI operation and control group. In control group, the mPAR was significantly higher than pre-PCI, the hs-CRP had no significant differences compared with pre-PCI operation. 24 hours and 7 days after PCI, no significant differences could be observed in the mPAR and hs-CRP of two groups. The hs-CRP was positively correlated with mPAR in tirofiban group at different time points in perioperative period. In control group, the hs-CRP was positively correlated with mPAR in pre-PCI operation and 24 hours post-PCI; the correlation was not found in 6 hours post-PCI and 7days post-PCI. Con- chtsion On the basis of double anti-platelet treatment, the platelet function is further inhibited by tirofiban in patients with NSTE-ACS 6 hours after PCI. The levels of hs-CRP have a predictive value for platelet function to some extent.