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目的:检测急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)术前后血浆中血栓素蛋白1(TSP-1)水平,分析其与不稳定斑块、血小板水平的相关性。方法:酶联免疫吸附实验检测24例急性ST段抬高型心肌梗死患者(A组)、20例慢性稳定型冠心病患者(B组)、20名冠脉造影正常的对照者(C组)的血液标本中TSP-1水平。AMI患者均按照指南规范服用阿司匹林、氯吡格雷。结果:3组基线临床特征在性别、年龄、风险因素及服用药物方面无统计学差异,具有可比性。研究对象入院时A组CRP、IL-6水平均高于C组,P<0.01,支持A组冠脉血管斑块处于不稳定阶段;入院时A组TSP-1水平(312±160)ng/L,高于B组及C组,P<0.05。术前准备阶段服用阿司匹林和氯吡格雷后,TSP-1水平升高,3组较入院时分别增加(14±10)%,(22±15)%,(17±10)%,组间比较无统计学差异。PCI术或冠脉造影术后TSP-1水平变化显著,3组较入院时分别增加(55±21)%,(61±25)%,(56±19)%,均为P<0.01,与入院时比较有显著性差异,提示PCI或冠脉造影术明显促进TSP-1释放。结论:急性ST段抬高型心肌梗死时TSP-1、CRP、IL-6水平均明显高于稳定冠心病组及对照组,TSP-1升高与不稳定斑块密切相关。阿司匹林和氯比格雷药物抑制血小板活化,增加TSP-1表达;PCI术后TSP-1表达显著增加,初步分析与PCI术操作本身、术中应用肝素钠针以及替罗非班等有关。
Objective: To detect the plasma levels of thrombospondin 1 (TSP-1) in patients with acute myocardial infarction (AMI) before and after percutaneous coronary intervention (PCI) and analyze the correlation with plasma plaque and unstable plaque. Methods: Twenty-four patients with acute ST-elevation myocardial infarction (group A), 20 patients with chronic stable coronary heart disease (group B) and 20 patients with normal coronary angiography (group C) TSP-1 levels in blood samples. AMI patients are taking aspirin, clopidogrel in accordance with the guidelines. Results: There was no significant difference in the baseline clinical features among the three groups in terms of sex, age, risk factors and taking drugs. The levels of CRP and IL-6 in group A were significantly higher than those in group C (P <0.01), and the coronary artery plaque in group A was in an unstable phase. The level of TSP-1 in group A was (312 ± 160) ng / L, higher than those in group B and group C, P <0.05. The level of TSP-1 increased after taking aspirin and clopidogrel in the preoperative preparation stage. The levels of TSP-1 in the three groups increased by (14 ± 10)%, (22 ± 15)% and (17 ± 10)%, respectively No statistical difference. The level of TSP-1 changed significantly after PCI or coronary angiography. The levels of TSP-1 in the three groups were (55 ± 21)%, (61 ± 25)% and (56 ± 19)%, respectively, There were significant differences at admission, suggesting that PCI or coronary angiography significantly promoted the release of TSP-1. CONCLUSIONS: The levels of TSP-1, CRP and IL-6 in patients with acute ST-elevation myocardial infarction were significantly higher than those in patients with stable coronary heart disease and controls. Elevated TSP-1 was closely associated with unstable plaques. Aspirin and clopidogrel drugs inhibited platelet activation and increased the expression of TSP-1. The expression of TSP-1 was significantly increased after PCI. The preliminary analysis was related to PCI operation itself, intraoperative use of heparin sodium needle and tirofiban.