PTCA及血管内支架术中冠脉循环血小板功能的变化

目的 探讨经皮腔内冠脉成形术（PTCA）及冠脉内支架术对冠脉循环中血小板功能的影响。方法 29例冠心病患者分成冠脉造影组（8例）和PTCA加支架组（21例），分别于术前及术后即刻采集冠状静脉窦血，采用比浊法测定血小板最大聚集率（MPAR），放免法测定血小板α-颗粒膜蛋白（GMP－140）及血栓素B2（TXB2）的浓度。并对PTCA及支架术中不同时间点血小板功能指标的变化情况进行了观察。结果 冠脉造影前后血小板功能指标无显著变化；PTCA及支架组在球囊预扩张即刻各血小板功能指标均轻度增高；支架后即刻显著升高（P＜0．05），支架后10min有下降趋势。结论 冠脉造影对冠脉循环血小板功能无显著影响；PTCA及支架术中能使血小板功能激活。

PTCA and stents implantation activate platelet function in coronary circulation

AIM To assess the effects of percutaneous transluminal coronaryangioplasty (PTCA) and in-stent implantation on platelet function in the coronary circulation of the patients with coronary heart disease. METHODS Eight patients underwent angiography and 21 patients with coronary heart disease underwent PTCA and in-stent implantation.Blood samples were obtained from the coronary sinus immediately before and after angiography or in-stent implantation, 1 min after the first pre-stent balloon dilation and 10 min after in-stent. The plasma levels of GMP-140 and TXB2 were measured by radioimmunoassay. MPAR (Maximal Platelet Aggregation Rate) were determined using enhanced turbidity. RESULTS Although no change of the platelet function was found after angiography alone, there were a slight increase after the balloon dilation, a significant increase immediately after in-stent GMP-140 from (8.31±0.39) to (10.31±0.49) μg·L-1, TXB2 from (302.59±25.57) to (363.94±30.33) ng·L-1, MPAR from (22.5±4.77)% to (38.95±6.6)%; P<0.05,and a decreased trend 10 min after in-stent implantation. CONCLUSION The finding suggests that platelet function in coronary circulation may be activated during PTCA and in-stent implantation, but not during angiography alone.