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目的:观察冠心病支架置入后发生氯吡格雷抵抗的患者术前、术后血清妊娠相关蛋白A(PAPP-A)和肿瘤坏死因子-α(TNF-α)水平的变化及意义。方法:选取因冠心病不稳定型心绞痛住院并成功接受冠状动脉支架置入术的患者102例,分别于术前、术后24h抽取外周血,根据比浊法检测ADP诱导的血小板聚集率结果,分为氯吡格雷抵抗组和正常反应组。酶联免疫法测定血清PAPP-A和TNF-α水平,分析氯吡格雷不同反应性的发生与PAPP-A和TNF-α水平的关系。结果:冠状动脉介入术后24h氯吡格雷抵抗的发生率为33.3%,氯吡格雷抵抗组患者术后24h血清PAPP-A水平(73·8±34mIU·L-1)与术前(47·6±37·3mIU·L-1)和正常反应组术后(22·5±6·3mIU·L-1)比较,差异均有统计学意义(P<0·05),TNF-α水平有升高趋势,但差异无统计学意义。其中血PAPP-A水平(r=1.216,P<0·05)与氯吡格雷抵抗的发生密切相关。结论:冠状动脉支架术后对氯吡格雷具有不同反应性的患者血PAPP-A、TNF-α水平存在差异,PAPP-A可能与氯吡格雷抵抗事件的发生有关。
Objective: To observe the changes and significance of serum levels of pregnancy-related protein A (PAPP-A) and tumor necrosis factor-α (TNF-α) in patients with clopidogrel resistance after coronary stent implantation. Methods: A total of 102 patients admitted to hospital with unstable angina pectoris undergoing coronary stent implantation were enrolled in this study. Peripheral blood was taken before and 24 h after operation. The ADP-induced platelet aggregation rate was measured by turbidimetry. Divided into clopidogrel resistance group and normal reaction group. The serum levels of PAPP-A and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA). The relationship between the different reactivity of clopidogrel and the levels of PAPP-A and TNF-α was analyzed. Results: The incidence of clopidogrel resistance was 33.3% at 24 h after coronary intervention and at 24 h after operation (47 · 8 ± 34 mIU · L-1) in patients with clopidogrel resistance 6 ± 37 · 3mIU · L-1) and normal reaction group (22 · 5 ± 6 · 3mIU · L-1), the differences were statistically significant (P <0 · 05), TNF- Rising trend, but the difference was not statistically significant. The blood level of PAPP-A (r = 1.216, P <0.05) was closely related to the occurrence of clopidogrel resistance. CONCLUSION: The levels of PAPP-A and TNF-α in blood of patients with different reactivity to clopidogrel after coronary stenting are different. PAPP-A may be related to the occurrence of clopidogrel resistance.