流式细胞术在抗血小板治疗中的临床应用

 目的   使用全血流式细胞术观察抗血小板治疗对急性冠脉综合症(acute coronary syndrome,ACS)患者血小板的影响,评估临床使用该方法的可行性。方法  选取2012.1.1至2012.5.31期间在华山医院首次确诊为ACS的患者。其中男性10例,女性10例,年龄57~72岁。分别于所有治疗开始前以及治疗后第8天采血。使用流式细胞仪检测患者血小板静息状态纤维蛋白原受体(PAC-1)和P选择素(CD62p)表达比例,以及二磷酸腺苷(adenosine diphosphate,ADP)诱导血小板活化后的PAC 1、CD62p表达比例；使用血小板双通道聚集仪测定患者血小板聚集率。另设20例健康志愿者做为对照组。结果   治疗前,ACS患者静息血小板PAC-1和CD62p高表达；使用ADP体外刺激血小板活化,ACS患者血小板活化水平高于对照组。使用阿司匹林联合氯吡格雷治疗后,患者循环活化血小板数量下降,但仍高于对照组;使用ADP体外刺激血小板活化,ACS患者血小板PAC-1和CD62p较治疗前下降,其中,PAC-1表达水平低于对照组。结论   ACS患者PAC-1、CD62p表达高于健康人,循环活化血小板数量升高,抗血小板治疗可以显著抑制患者血小板功能。合理使用全血流式细胞术可以用于临床抗血小板治疗评估。

Clinical application of flow cytometry in the treatment of antiplatelet

Objective   To investigate the clinical application of flow cytometry in the patients with acute coronary syndrome (ACS) and quantifying the effect of antiplatelet therapy on platelet function, with the aim to guide the clinical practice.Methods    Patients between 57-72 years old with chest pain suggestive of new-onset ACS (20 cases,10 males and 10 females) were eligible from Jan.1 to May 31,2012 in Huashan Hospital. Whole blood was taken before and 8 days after antiplatelet treatment. Fibrinogen receptor (PAC-1 binding) and P-selectin (CD62p expression) were determined on resting and adenosine diphosphate (ADP) active ated platelets from ACS patients by flow cytometry. The rates of platelet aggregation was determined in a multichannel aggregometer. The healthy volunteers 20 cases was obtained as control group. Results     PAC-1 and CD62p was higher in ACS patients than that of the control group with or without ADP activated before treatment. Aspirin and clopidogrel therapy decreased the number of CAP in patients,but still higher than control group. Compared with pre treatment,antiplatelet therapy reduced PAC-1 and CD62p with ADP activated in patients. Compared with control group,antiplatelet therapy attenuated PAC-1 on ADP-activated platelets more significantly. Conclusions    PAC-1 binding and CD62p expression was higher in ACS patients,and with high numbers of CAP. Antiplatelet treatment significantly inhibits platelet function. Flow cytometry can be used in the assessment of antiplatelet treatment.