联合应用抗血小板药物对老年急性冠状动脉综合征患者血小板活化功能的影响

目的探讨不同剂量阿司匹林与氯吡格雷联合应用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。方法将89例老年ACS患者分为阿司匹林100 mg/d单独应用组(A100组)、氯吡格雷75 mg/d与阿司匹林300 mg/d联合应用组(AC300组)及氯吡格雷75 mg/d与阿司匹林100 mg/d联合应用组(AC100组),运用流式细胞仪测定各组血小板膜糖蛋白(GP)Ⅱ b/Ⅲ a及P选择素的阳性表达率变化。结果用药2周后,AC100组、AC300组与A100组P选择素的阳性表达率分别为(35.65±18.32)%、(25.69±14.78)%与(60.44±9.30)%,与A100组比较明显降低(P0.01);GP Ⅱ b/Ⅲ a的阳性表达率分别为(34.49±13.33)%、(24.86±14.62)%与(57.22±15.82)%,与A100组比较显著降低(P0.01)。AC300组较AC100组血小板GPⅡ b/Ⅲ a和P选择素的阳性表达率也明显降低,差异有统计学意义(P0.05)。结论氯吡格雷和阿司匹林联合应用抗血小板活化疗效在老年ACS患者中好于阿司匹林单独应用,AC300组抗血小板活化疗效呈剂量依赖性;检测血小板活化率可以反映抗血小板药物联合应用对老年ACS患者血小板活化功能的影响。

Effect of combined use of antiplatelet agents on platelet activation function in elderly patients with acute coronary sydrome

Objective To investigate the effect of combination of different doses of aspirin and clopidogrel on platelet activation function in the elderly patients with acute coronary syndrome (ACS).Methods Eighty-nine elderly patients with ACS were divided randomly into three groups:aspirin 100 mg/d alone( A100) ,clopidogrel 75 mg/d + aspirin 300 mg/d(AC300) and clopidogrel 75 mg/d + aspirin 100 mg/d(AC100).The positive expression of glycoprotein Ⅱb/Ⅲa (GPⅡb/Ⅲa) and P-selectin on the surface of platelets were assessed by flow cytometry in different groups after the platelets were activated by adenosine diphosphate and arachidonic acid. Results The expression rates of GP Ⅱb/Ⅲa in A100,AC300 and AC100 groups were (57.22 ± 15.82) % ,(24.86 ± 14.62) % ,(34.49± 13.33) % ,and P-selectin were(60.44 ±9.30) % ,(25.69 ± 14.78)% and(35.65 ± 18.32)% respectively.Compared with A100 group,the expresion rates of GP Ⅱb/Ⅲa and P-selectin were significantly decreased in AC300 and AC100 groups (P <0.01). The expression rates of GPⅡb/Ⅲa and P-selectin in AC300 group was significanty lower than those in AC100 group (P < 0.05).Conclusions Aspirin combined with clopidogrel has better efficacy in inhibiting the activation of platelets than aspirin alone.The antiplatlet effect relies on the dose.The influence on the platelet activation in elderly patients with ACS can be assessed through examining GP Ⅱb/Ⅲa and P-selectin expression on the surface of platelet.