中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
9期
1258-1261,1262
,共5页
李月平%赵迎新%刘宇扬%史冬梅%周玉杰
李月平%趙迎新%劉宇颺%史鼕梅%週玉傑
리월평%조영신%류우양%사동매%주옥걸
急性冠状动脉综合征%他汀类%血小板参数%经皮冠状动脉介入
急性冠狀動脈綜閤徵%他汀類%血小闆參數%經皮冠狀動脈介入
급성관상동맥종합정%타정류%혈소판삼수%경피관상동맥개입
Acute coronary syndrome%Statins%Platelet parameter%Percutaneous coronary interven-tion
目的：探讨经皮冠状动脉介入（ PCI）术前短期、强化他汀类药物治疗对高龄非ST段抬高型急性冠状动脉综合征患者血小板相关参数的影响。方法选取首都医科大学附属北京安贞医院因不稳定型心绞痛或非ST段抬高型心肌梗死行PCI的患者138例。 PCI术前12 h用随机数字表法分为2组：他汀常规治疗（阿托伐他汀20 mg/d）组70例，强化治疗（阿托伐他汀80 mg负荷剂量，随之40 mg/d）组68例。入院后检测基线血小板参数[血小板计数、平均血小板体积（ MPV）、血小板分布宽度（ PDW）、大血小板比例（P-LCR）]。 PCI术后第1、5天复查血小板参数，检测花生四烯酸（AA）和二磷酸腺苷（ADP）诱导的血小板聚集率。结果2组患者入院后基线、PCI术后第1、5天的血小板计数、MPV、PDW、P-LCR比较，差异均无统计学意义（均P＞0．05）。与基线比较，常规治疗组PCI术后第1天血小板计数下降，MPV、PDW和P-LCR增加，差异均有统计学意义[（206±62）×109/L比（210±60）×109/L、（10．8±0．9）fL比（10．6±0．9）fL、（12．8±1．9）％比（12．5±1．9）％、（32±8）％比（30±8）％]（P＜0．05）；常规治疗组PCI术后第5天血小板计数、MPV、PDW、P-LCR与基线比较，差异无统计学意义（P＞0．05）。强化治疗组PCI术后第1天血小板计数、MPV、PDW及P-LCR与基线比较，差异无统计学意义（ P＞0．05）；PCI术后第5天MPV及P-LCR与基线比较，差异有统计学意义[（10．6±1．0）fL比（10．8±1．0）fL、（30±9）％比（31±8）％]（P＜0．05）。2组PCI术后第1、5天AA和ADP诱导的血小板聚集率比较，差异无统计学意义（P＞0．05）；组内AA和ADP诱导的血小板聚集率比较，差异无统计学意义（ P＞0．05）。结论对于高龄非ST段抬高型急性冠状动脉综合征患者，强化他汀类药物治疗能有效抑制PCI术后MPV、L-PCR等的升高，抑制介入相关的血小板激活。
目的：探討經皮冠狀動脈介入（ PCI）術前短期、彊化他汀類藥物治療對高齡非ST段抬高型急性冠狀動脈綜閤徵患者血小闆相關參數的影響。方法選取首都醫科大學附屬北京安貞醫院因不穩定型心絞痛或非ST段抬高型心肌梗死行PCI的患者138例。 PCI術前12 h用隨機數字錶法分為2組：他汀常規治療（阿託伐他汀20 mg/d）組70例，彊化治療（阿託伐他汀80 mg負荷劑量，隨之40 mg/d）組68例。入院後檢測基線血小闆參數[血小闆計數、平均血小闆體積（ MPV）、血小闆分佈寬度（ PDW）、大血小闆比例（P-LCR）]。 PCI術後第1、5天複查血小闆參數，檢測花生四烯痠（AA）和二燐痠腺苷（ADP）誘導的血小闆聚集率。結果2組患者入院後基線、PCI術後第1、5天的血小闆計數、MPV、PDW、P-LCR比較，差異均無統計學意義（均P＞0．05）。與基線比較，常規治療組PCI術後第1天血小闆計數下降，MPV、PDW和P-LCR增加，差異均有統計學意義[（206±62）×109/L比（210±60）×109/L、（10．8±0．9）fL比（10．6±0．9）fL、（12．8±1．9）％比（12．5±1．9）％、（32±8）％比（30±8）％]（P＜0．05）；常規治療組PCI術後第5天血小闆計數、MPV、PDW、P-LCR與基線比較，差異無統計學意義（P＞0．05）。彊化治療組PCI術後第1天血小闆計數、MPV、PDW及P-LCR與基線比較，差異無統計學意義（ P＞0．05）；PCI術後第5天MPV及P-LCR與基線比較，差異有統計學意義[（10．6±1．0）fL比（10．8±1．0）fL、（30±9）％比（31±8）％]（P＜0．05）。2組PCI術後第1、5天AA和ADP誘導的血小闆聚集率比較，差異無統計學意義（P＞0．05）；組內AA和ADP誘導的血小闆聚集率比較，差異無統計學意義（ P＞0．05）。結論對于高齡非ST段抬高型急性冠狀動脈綜閤徵患者，彊化他汀類藥物治療能有效抑製PCI術後MPV、L-PCR等的升高，抑製介入相關的血小闆激活。
목적：탐토경피관상동맥개입（ PCI）술전단기、강화타정류약물치료대고령비ST단태고형급성관상동맥종합정환자혈소판상관삼수적영향。방법선취수도의과대학부속북경안정의원인불은정형심교통혹비ST단태고형심기경사행PCI적환자138례。 PCI술전12 h용수궤수자표법분위2조：타정상규치료（아탁벌타정20 mg/d）조70례，강화치료（아탁벌타정80 mg부하제량，수지40 mg/d）조68례。입원후검측기선혈소판삼수[혈소판계수、평균혈소판체적（ MPV）、혈소판분포관도（ PDW）、대혈소판비례（P-LCR）]。 PCI술후제1、5천복사혈소판삼수，검측화생사희산（AA）화이린산선감（ADP）유도적혈소판취집솔。결과2조환자입원후기선、PCI술후제1、5천적혈소판계수、MPV、PDW、P-LCR비교，차이균무통계학의의（균P＞0．05）。여기선비교，상규치료조PCI술후제1천혈소판계수하강，MPV、PDW화P-LCR증가，차이균유통계학의의[（206±62）×109/L비（210±60）×109/L、（10．8±0．9）fL비（10．6±0．9）fL、（12．8±1．9）％비（12．5±1．9）％、（32±8）％비（30±8）％]（P＜0．05）；상규치료조PCI술후제5천혈소판계수、MPV、PDW、P-LCR여기선비교，차이무통계학의의（P＞0．05）。강화치료조PCI술후제1천혈소판계수、MPV、PDW급P-LCR여기선비교，차이무통계학의의（ P＞0．05）；PCI술후제5천MPV급P-LCR여기선비교，차이유통계학의의[（10．6±1．0）fL비（10．8±1．0）fL、（30±9）％비（31±8）％]（P＜0．05）。2조PCI술후제1、5천AA화ADP유도적혈소판취집솔비교，차이무통계학의의（P＞0．05）；조내AA화ADP유도적혈소판취집솔비교，차이무통계학의의（ P＞0．05）。결론대우고령비ST단태고형급성관상동맥종합정환자，강화타정류약물치료능유효억제PCI술후MPV、L-PCR등적승고，억제개입상관적혈소판격활。
Objective To investigate the impact of intensive statin therapy on perioperative platelet pa -rameters in older patients with non-ST elevated acute coronary syndrome ( NSTE-ACS ) undergoing percutaneous coronary intervention (PCI).Methods A total of 138 patients, over 65 year′s age, with unstable angina pectoris or non ST segment elevation myocardial infarction were included .They were divided into conventional therapy group ( received 20 mg atorvastatin per day , n=70 ) and intensive treatment group ( received 80 mg load dose of atorvastatin then 40 mg per day, n=68) 12 hours before PCI.Blood platelet count (PLT), mean platelet volume (MPV), platelet distribution (PDW) and platelet-large cell ratio (P-LCR) were measured at baseline; platelet parameters were measured at day 1 and day 5 after PCI, including the platelet aggregation rate induced arachidonic acid and adenosine diphosphate .Results There were no significant differences on PLT , MPV, PDW, P-LCR af-ter admission and PCI at day 1 and day 5 between the two groups (P>0.05).Compared with base line, there were significant differences on PLT , MPV, PDW, P-LCR after admission and day 1 after PCI in conventional ther-apy group,[(206 ±62) ×109/L vs (210 ±60) ×109/L,(10.8 ±0.9)fL vs (10.6 ±0.9)fL, (12.8 ±1.9)%vs (12.5 ±1.9)%, (32 ±8)%vs (30 ±8)%] (P<0.05).The fifth day after PCI, there were no significant differences of platelet count, MPV, PDW, P-LCR in conventional treatment group and baseline (P>0.05).The first day after PCI , there were no significant differences of platelet count , MPV, PDW, P-LCR in intensive treat-ment group and baseline(P>0.05);there were significant differences in MPV and P-LCR in intensive treatment group and base line [(10.6 ±1.0)fL vs (10.8 ±1.0)fL, (30 ±9)%vs (31 ±8)%](P<0.05).The first and fifth day after PCI , there were no significant differences in platelet aggregation rate of AA and ADP in two groups ( P>0.05 ); there were no significant differences in platelet aggregation rate of AA and ADP abduction in all groups (P>0.05).Conclusions Atorvastatin may beneficially inhibit the increasing of MPV , PDW, P-LCR due to PCI.This effect of atorvastatin can play a role in decreasing platelet activation and reducing cardiovascular risk for NSTE-ACS patients .
