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目的探讨不稳定型心绞痛(UAP)患者经皮冠状动脉介入治疗(PCI)后假性血友病因子(vWF)和血小板α颗粒蛋白(GMP-140)水平的变化规律及临床意义。方法连续观察35例(A组)UAP患者PCI术前及术后1、24、72 h血液中vWF和GMP-140的变化。另设单纯行冠脉造影的UAP患者30例(B组)和健康者30例(C组)作对照。vWF和GMP-140分别用酶联免疫吸附双抗体夹心法测定血浆含量,并随访术后3个月心血管事件的发生情况。结果vWF在A、B组的浓度显著高于C组(P<0.01),A组介入治疗后1 h进一步升高,持续至24 h(P<0.05),然后逐渐回落;B组术前与术后无显著改变。A、B组GMP-140的浓度显著高于C组(P<0.05),A组介入治疗后在1 h即达峰值(P<0.01),然后迅速回落,72 h至术前水平;随访期内B组心血管事件发生率显著高于A组(57%vs14%,P<0.01)。结论UAP患者介入治疗后vWF、GMP-140在72 h内有动态变化,反映了PCI后冠脉内皮功能受损和血小板激活上述指标持续升高,可能是术后早期心血管事件的危险因素。
Objective To investigate the changes and clinical significance of von Willebrand factor (vWF) and platelet α-particle protein (GMP-140) in patients with unstable angina pectoris (UAP) after percutaneous coronary intervention (PCI). Methods The changes of vWF and GMP-140 in blood of 35 UAP patients (group A) before PCI and at 1, 24 and 72 h after PCI were observed continuously. Another simple line of coronary angiography in patients with UAP 30 cases (group B) and 30 healthy subjects (group C) as a control. Plasma levels of vWF and GMP-140 were measured by sandwich enzyme-linked immunosorbent assay (ELISA) and follow-up of cardiovascular events at 3 months. Results The concentration of vWF in group A and group B was significantly higher than that in group C (P <0.01), and the level of vWF in group A was further increased at 1 hour after interventional therapy and continued to 24 h (P <0.05) No significant change after surgery. The concentration of GMP-140 in group A and group B was significantly higher than that in group C (P <0.05), and peaked at 1 hour after intervention in group A (P <0.01) The incidence of cardiovascular events in group B was significantly higher than that in group A (57% vs14%, P <0.01). Conclusion The dynamic changes of vWF and GMP-140 in UAP patients within 72 h after interventional therapy reflect the continuous increase of coronary endothelial dysfunction and platelet activation after PCI, which may be the risk factors of early postoperative cardiovascular events.