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目的观察预服氯吡格雷对冠心病患者PCI术后血浆纤溶酶原激活抑制剂(PAI-1)及组织型纤溶酶原激活物(t-PA)的影响。方法45例在该院接受冠状动脉介入治疗的稳定型心绞痛患者随机分为2组,试验组(n=30)术前至少12～24h予以75mg的硫酸氯吡格雷口服,对照组(n=15)术后立即予以300mg负荷剂量口服,所有受试者均分别于PCI术前清晨空腹和PCI术后24h采血,检测血浆PAI-1和t-PA水平。结果PCI术前试验组与对照组PAI-1和t-PA水平均差异无显著性(P>0.05),PCI术后,对照组PAI-1较术前升高(P<0.05),试验组PAI-1较术前降低(P<0.05),而2组t-PA改变均不明显(P>0.05)。结论血小板活化是PCI术后抗纤溶蛋白增高的主要来源,PCI术前预服氯吡格雷可改善纤溶系统,减少术后支架内血栓的形成。
Objective To observe the effect of clopidogrel pre-serving on plasma plasminogen activator inhibitor (PAI-1) and tissue plasminogen activator (t-PA) after PCI in patients with coronary heart disease. Methods Forty-five patients with stable angina pectoris undergoing coronary intervention in our hospital were randomly divided into two groups. The experimental group (n = 30) was given oral clopidogrel sulfate 75 mg orally at least 12 to 24 hours before operation, while the control group (n = 15 ) Were given oral dose of 300mg immediately after operation, all subjects were fasting in the early morning before PCI and 24h after PCI, blood samples were collected to detect plasma PAI-1 and t-PA levels. Results There was no significant difference in the levels of PAI-1 and t-PA between PCI group and control group before PCI (P> 0.05). After PCI, PAI-1 in control group was significantly higher than that before PCI (P <0.05) PAI-1 was lower than that before operation (P <0.05), but no significant change was found in t-PA between the two groups (P> 0.05). Conclusion Platelet activation is the main source of elevated anti-fibrinolysis after PCI. Pre-serving clopidogrel before PCI can improve the fibrinolytic system and reduce the formation of thrombus in the stent.