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目的观察急性冠状动脉综合征患者介入治疗后血小板活化指标CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物及内皮功能的改变。方法60例急性冠状动脉综合征患者在冠状动脉介入术前和术后即刻以及次日采用流式细胞仪检测血小板活化指标CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物;双抗体夹心固相酶联免疫吸附试验测定血浆假血友病因子的表达水平;放射免疫测定法测定血浆内皮素1表达水平;酶法测定血浆一氧化氮的含量;彩色多谱勒超声诊断仪测量内皮依赖性血管舒张功能。选择健康体检者和稳定型心绞痛患者各30例作对照,观察急性冠状动脉综合征患者冠状动脉介入前后指标的变化并与对照组比较。结果与健康对照组和稳定型心绞痛组比,急性冠状动脉综合征组CD62p、CD63及糖蛋白Ⅱb/Ⅲa受体复合物明显增高(P<0.05或0.01);急性冠状动脉综合征患者介入术后即刻CD62p、CD63和糖蛋白Ⅱb/Ⅲa受体复合物与术前相比明显增高(P<0.01),但术后24h较术前无明显变化(P>0.05)。与健康对照组和稳定型心绞痛组比,急性冠状动脉综合征组假血友病因子、内皮素1的表达水平明显增高(P<0.01),内皮依赖性血管舒张功能和一氧化氮降低(P<0.05或<0.01);急性冠状动脉综合征患者介入术后即刻血浆假血友病因子和内皮素1水平升高(P<0.05或P<0.01),内皮依赖性血管舒张功能和一氧化氮水平降低(P<0.05),且介入术后24h假血友病因子水平也较术前升高(P<0.05),内皮依赖性血管舒张功能降低(P<0.05),但内皮素1和一氧化氮水平与术前差异无显著性(P>0.05)。结论血小板活化和内皮功能的损伤在急性冠状动脉综合征发生和发展过程中起重要的作用,冠状动脉介入术后血管内皮受到一定损伤,血小板有一定程度的激活。
Objective To observe the changes of platelet activation markers CD62p, CD63 and glycoprotein Ⅱb / Ⅲa receptor complex and endothelial function after interventional therapy in patients with acute coronary syndrome. Methods Sixty patients with acute coronary syndrome (ACS) were enrolled in this study. The platelet activation markers CD62p, CD63 and glycoprotein Ⅱb / Ⅲa receptor complex were detected by flow cytometry before and after coronary intervention. The double antibody sandwich solid phase Enzyme-linked immunosorbent assay (ELISA) was used to determine the expression of plasma fake hemophilia. Plasma levels of endothelin-1 were measured by radioimmunoassay. Enzyme-linked immunosorbent assay (ELISA) was used to determine the level of plasma nitric oxide. Endothelial-dependent vascular Diastolic function. 30 healthy volunteers and 30 patients with stable angina pectoris were selected as controls to observe the changes of indexes before and after coronary intervention in patients with acute coronary syndrome and compared with the control group. Results Compared with healthy control group and stable angina pectoris group, the levels of CD62p, CD63 and glycoprotein Ⅱb / Ⅲa receptor complex in acute coronary syndrome group were significantly increased (P <0.05 or 0.01); in patients with acute coronary syndrome The immediate CD62p, CD63 and glycoprotein Ⅱb / Ⅲa receptor complexes were significantly higher than those before operation (P <0.01), but no significant changes were observed 24h after operation (P> 0.05). Compared with healthy control group and stable angina pectoris group, the expression of von Willebrand factor, endothelin 1 in acute coronary syndrome group was significantly increased (P <0.01), and the endothelium-dependent vasodilatation and nitric oxide were decreased <0.05 or <0.01). In patients with acute coronary syndromes, plasma hemophilia and endothelin-1 levels increased immediately after PCI (P <0.05 or P <0.01), endothelium-dependent vasodilation and nitric oxide (P <0.05). Moreover, the level of Hyphemaemic factor (Hypophosphatemia) was also increased at 24h after PCI (P <0.05) and endothelium-dependent vasodilation was decreased (P <0.05) Nitric oxide levels were not significantly different from those before operation (P> 0.05). Conclusion Platelet activation and endothelial dysfunction play an important role in the occurrence and development of acute coronary syndrome. The vascular endothelium is damaged to a certain degree after coronary artery intervention and platelets are activated to some extent.