吸烟对老年急性冠状动脉综合征患者血小板活化功能的影响研究

为探讨吸烟对老年急性冠状动脉综合征（ACS）患者血小板活化功能的影响。将56例65岁以上老年ACS患者分为非吸烟组30例及吸炯组26例，均给予氯吡格雷75mg／d与阿司匹林100mg／d联合应用14d，运用流式细胞仪测定两组血小板膜糖蛋白Ⅱb／ma（GPb／ma）及P-选择素的m性表达率。结果显示，非吸炯组用药前GPIIb／ma、P-选择素的阳性表达牢分别为（67．86±12．14）％、（70．37±10．15）％，用药后分别下降为（50．18±8．72）％、（49．36±11．43）％，用药前后比较差异有统计学意义（均P〈0．01）。吸烟组用药前GPb／Ⅲa及P-选择素的阳性表达率分别为（79．47±11．62）％、（81．26±9．74）％，用药后分别下降为（61．15±9．29）％、（57．52±10．81）％，用药前后比较差异有统计学意义（均P〈0．01）。联合应用抗血小板药物14d后，非吸烟组较吸烟组血小板活化性降低幅度更明显，差异有统计学意义（均P〈0．05）。提示吸烟明显增加老年ACS患者GPlIb／11Ia技P-选择素阳性表达率，使血小板活化性增加；吸烟可能降低抗血小板药物氯吡格雷和阿司匹林联合应用抗血小板聚集的疗效。

Effect of cigarette smoking on platelet activation in elderly patients with acute coronary syndrome

Fifty six elderly patients with acute coronary syndrome （ACS） were divided into non- smoking group （ n = 30） and smoking group （ n = 26）. All patients rec.eived aspirin 100 mg/d ＋ Clopidogrel 75 mg/d for 14 d. Tile expression of glycoprotein [[ b/]]Ia and P-Seleetin on the surface of platelets in both groups were assessed with flow cytometry （FCM）. The positive expression rates of GP ]I b/~ a and P-Selectin before treatment were （ 67.86 ＋ 12. 14 ） %, （ 70. 37 ＋ 10. 15 ） % in non-smoking group and （ 79.47 ＋ 1 l. 62 ） %, （ 81.26 ＋ 9.74 ） % in smoking group. The positive expression rates of GP H b/IlI a and P-Selectin after treatment were significantly decreased to （50. 18 -＋ 8.72）%, （49.36 ＋ 11.43 ）% in non- smoking group and to （61.15 ＋9.29）%, （57.52 ＋10.81）% in smoking group（P〈0.01） . Also the degree of decreasing expression rates of GP [I b/m a and P-Selectin was more markedly in non-smoking group than that in smoking group （ P 〈 0. 05 ） . The results indicate that expressions of GP 1I b/m a and P-Selectin on the surface of platelets are increased in the elderly smoker patients with ACS, and smoking may decrease the effect of anti-platelet agents.