缺血性ST段或T波变化及病灶特征与 血小板功能的相关性

目的确立不稳定型心绞痛(UAP)患者缺血性ST段或T波变化及冠状动脉(冠脉)造影所示病灶特征与血小板功能的相关性。方法38例拟诊UAP患者分别依据胸痛发作时心电图(ECG)短暂性的ST段或T波改变及冠脉造影下病灶特征分组，流式细胞仪检测每例患者外周血糖蛋白(GP)Ⅱb/Ⅲa受体阳性表达的血小板比率，比较组间GPⅡb/Ⅲa受体表达差异。9例健康成人作对照组。结果胸痛发作时22例患者ECG有短暂性ST段变化，另16例表现为短暂性T波异常，ST段变化组GPⅡb/Ⅲa受体表达率(4.4±2.1)％，显著高于T波变化组(2.7±1.6)％，P＜0.01。冠脉造影示对应于ECG变化的罪犯病灶23例为复杂病变，13例为简单病变，2例未见有意义狭窄。复杂病变组血小板膜GPⅡb/Ⅲa受体表达率(4.6±2.5)％，显著高于简单病变组(2.2±1.1)％,P＜0.01。结论UAP患者胸痛发作时伴短暂ST段变化或冠脉造影示复杂性病变提示血小板功能增强，可能更适合抗血小板治疗。

Relationship among ischemic ST segment or T wave shifts, angiographic morphology and platelet function in patients with unstable angina

Objective:To determine the relations among specific clinical pictures ,including electrocardiogram (ECG) abnormalities associated with ischemia,angiographic morphology and plate let function. Method:Thirtyeight consecutive patients were divided into two groups according to ST segment or T waves changes associated with ischemia or angiographic morphology. Venous blood samples were measured for ratios of platelet glycoprotein (GP) Ⅱ b/Ⅲ a by flow cytometry. Result:Twenty-two of the 38 patients exhibited reversible ST segment depression (n＝ 20) or elevation (n＝ 2) during ischemic episodes, whereas the other 16 exhibited reversible T wave changes. Positive ratios of platelet GP Ⅱ b/Ⅲ a were different significantly between ST segment shift group and T wave change group (4.4±2.1)% vs (2.7± 1.6)%, P ＜0.01. Angiographic examinationamong the 38 patients showed complex lesions in 13 patients and no significant stenosis (＜50%) in 2 patients. The positive ratios of platelet GP Ⅱ b/Ⅲ a in complex lesion group were markedly elevated compared with noncomplex lesion group(4. 6±2.5)% vs (2.2±1.1)%, P ＜0. 01. Conclusion:The results suggest that the occurrence of reversible ST segment shifts associated with ischemia or complex lesions noted in angiographic examination identifies the increase of platelet activation in patients with unstable angina and who may be beneficial from antiplatelet therapy.