不同抗血小板治疗对急性脑梗死患者血小板活化聚集状态的比较

目的:探讨不同抗血小板治疗对脑梗死急性期患者血小板活化及聚集状态的影响?方法:97例脑梗死患者随机入组不同的抗血小板治疗组(阿司匹林治疗组?氯吡格雷治疗组?阿司匹林联合氯吡格雷治疗组),在入院第1天(治疗前)和第10天采用流式细胞仪检测血小板CD62P?比浊法检测花生四烯酸(arachidonic acid,AA)诱导的血小板最大聚集率(MARAA)和二磷酸腺苷(adenosine diphosphate,ADP)诱导的血小板最大聚集率(MARADP)?结果:3组患者入院第1天CD62P?MARAA?MARADP无显著差异,治疗10 d后3组的CD62P?MARAA?MARADP值均下降,与入院第1天的CD62P?MARAA?MARADP值比较,差异有统计学意义?3组脑梗死患者血小板MARADP下降程度组间比较有差异,氯吡咯雷治组MARADP下降明显,阿司匹林联合氯吡格雷治疗组下降更明显?血小板MARAA?血小板CD62P下降程度组间比较无显著差异?结论:阿司匹林?氯吡格雷?阿司匹林联合氯吡格雷3种抗血小板治疗方法均能有效减少脑梗死急性期的血小板活化,降低血小板最大聚集率,提示临床治疗均有效;氯吡格雷和阿司匹林联合治疗更能抑制血小板的聚集,抗血小板疗效更好?

Study of the influence on the platelet activation and aggregation in patients with acute cerebral infarction which received different antiplatelet therapy

Objective:To investigate the influence of different antiplatelet therapies on the platelet activation and aggregation in patients with acute cerebral infarction. Methods:CD62P was measured by flow cytometry,arachidonic acid-induced platelet maximal aggregation rate(MARAA),adenosine diphosphate-induced platelet maximal aggregation rate(MARADP)were performed by turbidimetry. A total of 97 cerebral infarction patients were randomly divided into different antiplatelet therapy groups(the aspirin group,the clopidogrel group and the aspirin plus clopidogrel group). CD62P,MARAA and MARADP were measured on the 1st day (before treatment)and 10th day after admission. Results:On the first day,comparisons of CD62P,MARAA and MARADP among the three treatment groups were not significant. The levels of CD62P,MARAA and MARADP in each group were significantly decreased from 1 day to 10 day after admission. Comparison of MARADP decrease extent among the three treatment groups was significant,MARADP of the aspirin plus clopidogrel group decreased more distinctly than the clopidogrel group and even more than the aspirin group. Comparisons of CD62P and MARAA decrease extent among three treatment groups was not significant. Conclusion:Three antiplatelet therapies(aspirin,clopidogrel,aspirin plus clopidogrel) all reduced platelet activation and maximum aggregation rate,which indicated that each antiplatelet therapy was effective. Aspirin plus clopidogrel therapy could most significantly reduce platelet aggregation,which indicated that the curative effect was better among three antiplatelet therapys.