高龄非ST段抬高型急性冠状动脉综合征患者经皮冠状动脉介入术前强化他汀类药物治疗对围术期血小板相关参数的影响

目的：探讨经皮冠状动脉介入（ PCI）术前短期、强化他汀类药物治疗对高龄非ST段抬高型急性冠状动脉综合征患者血小板相关参数的影响。方法选取首都医科大学附属北京安贞医院因不稳定型心绞痛或非ST段抬高型心肌梗死行PCI的患者138例。 PCI术前12 h用随机数字表法分为2组：他汀常规治疗（阿托伐他汀20 mg/d）组70例，强化治疗（阿托伐他汀80 mg负荷剂量，随之40 mg/d）组68例。入院后检测基线血小板参数[血小板计数、平均血小板体积（ MPV）、血小板分布宽度（ PDW）、大血小板比例（P-LCR）]。 PCI术后第1、5天复查血小板参数，检测花生四烯酸（AA）和二磷酸腺苷（ADP）诱导的血小板聚集率。结果2组患者入院后基线、PCI术后第1、5天的血小板计数、MPV、PDW、P-LCR比较，差异均无统计学意义（均P＞0．05）。与基线比较，常规治疗组PCI术后第1天血小板计数下降，MPV、PDW和P-LCR增加，差异均有统计学意义[（206±62）×10^9/L比（210±60）×10^9/L、（10．8±0．9）fL比（10．6±0．9）fL、（12．8±1．9）％比（12．5±1．9）％、（32±8）％比（30±8）％]（P＜0．05）；常规治疗组PCI术后第5天血小板计数、MPV、PDW、P-LCR与基线比较，差异无统计学意义（P＞0．05）。强化治疗组PCI术后第1天血小板计数、MPV、PDW及P-LCR与基线比较，差异无统计学意义（ P＞0．05）；PCI术后第5天MPV及P-LCR与基线比较，差异有统计学意义[（10．6±1．0）fL比（10．8±1．0）fL、（30±9）％比（31±8）％]（P＜0．05）。2组PCI术后第1、5天AA和ADP诱导的血小板聚集率比较，差异无统计学意义（P＞0．05）；组内AA和ADP诱导的血小板聚集率比较，差异无统计学意义（ P＞0．05）。结论对于高龄非ST段抬高型急性冠状动脉综合征患者，强化他汀类药物治疗能有效抑制PCI术后MPV、L-PCR等的升高，抑制介?

Impact of intensive statin therapy on perioperative platelet parameters in older patients with non-ST segment elevated acute coronary syndrome undergoing percutaneous coronary interventions procedure

Objective To investigate the impact of intensive statin therapy on perioperative platelet pa -rameters in older patients with non-ST elevated acute coronary syndrome （ NSTE-ACS ） undergoing percutaneous coronary intervention （PCI）.Methods A total of 138 patients, over 65 year′s age, with unstable angina pectoris or non ST segment elevation myocardial infarction were included .They were divided into conventional therapy group （ received 20 mg atorvastatin per day , n=70 ） and intensive treatment group （ received 80 mg load dose of atorvastatin then 40 mg per day, n=68） 12 hours before PCI.Blood platelet count （PLT）, mean platelet volume （MPV）, platelet distribution （PDW） and platelet-large cell ratio （P-LCR） were measured at baseline; platelet parameters were measured at day 1 and day 5 after PCI, including the platelet aggregation rate induced arachidonic acid and adenosine diphosphate .Results There were no significant differences on PLT , MPV, PDW, P-LCR af-ter admission and PCI at day 1 and day 5 between the two groups （P〉0.05）.Compared with base line, there were significant differences on PLT , MPV, PDW, P-LCR after admission and day 1 after PCI in conventional ther-apy group,[（206 ±62） ×10^9/L vs （210 ±60） ×10^9/L,（10.8 ±0.9）fL vs （10.6 ±0.9）fL, （12.8 ±1.9）%vs （12.5 ±1.9）%, （32 ±8）%vs （30 ±8）%] （P〈0.05）.The fifth day after PCI, there were no significant differences of platelet count, MPV, PDW, P-LCR in conventional treatment group and baseline （P〉0.05）.The first day after PCI , there were no significant differences of platelet count , MPV, PDW, P-LCR in intensive treat-ment group and baseline（P〉0.05）;there were significant differences in MPV and P-LCR in intensive treatment group and base line [（10.6 ±1.0）fL vs （10.8 ±1.0）fL, （30 ±9）%vs （31 ±8）%]（P〈0.05）.The first and fifth day after PCI , there were no significant differences in platelet aggregation rate of AA and ADP in two groups ?