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目的:研究急性心肌梗死(AMI)患者外周血CD41/CD61(血小板膜糖蛋白Ⅱb/Ⅲa受体,GPⅡb/Ⅲa受体)的表达和血清C-反应蛋白(CRP)的变化,探讨两者之间的相关性及对预后的影响。方法:采用流式细胞仪技术测定51例AMI患者外周血CD41/CD61,并与20例正常对照组比较;采用免疫散射比浊法测定AMI患者血清CRP的系列变化值,取其峰值。AMI患者入院时按心功能分为AMI1组(KillipⅠ、Ⅱ级,27例)和AMI2组(KillipⅢ、Ⅳ级,24例)。对AMI患者进行随访。结果:AMI患者的CD41/CD61表达及CRP水平显著高于正常对照组(P<0·01);AMI2组的CD41/CD61表达及CRP峰值水平显著高于AMI1组(P<0·05或P<0·01);血小板的变化在上述2组间差异无统计学意义。AMI患者外周血CRP峰值与CD41/CD61表达呈显著性正相关(r=0·754,P<0·01)。AMI组中心脏事件者(15例,包括随访1年内的再发AMI、再住院行心肌血管重建术、住院期间及随访期内的心源性死亡者)与随访1年内无心脏事件者(36例)相比,CD41/CD61表达差异有统计学意义(P<0·05)。结论:AMI患者血小板被激活,且其活化程度与患者心功能状态有一定关系,CD41/CD61激活与炎症因子CRP有相关性,血小板激活及炎症因子可能都是影响AMI患者病情进展及预后的重要因素。
Objective: To study the changes of CD41 / CD61 (platelet glycoprotein Ⅱ b / Ⅲa receptor, GPⅡb / Ⅲa receptor) and serum C-reactive protein (CRP) in peripheral blood of patients with acute myocardial infarction (AMI) The correlation between and the impact on prognosis. Methods: Flow cytometry was used to detect CD41 / CD61 in peripheral blood of 51 AMI patients and compared with 20 normal controls. Serum CRP level was measured by immunostaining turbidimetry and the peak value was taken. AMI patients were divided into AMI1 group (KillipⅠ, Ⅱ grade, 27 cases) and AMI2 group (KillipⅢ, Ⅳ grade, 24 cases) according to cardiac function. AMI patients were followed up. Results: The expression of CD41 / CD61 and the level of CRP in AMI patients were significantly higher than those in normal controls (P <0.01). The CD41 / CD61 expression and CRP peak levels in AMI2 patients were significantly higher than those in AMI1 patients (P <0.05 or P <0.01). There was no significant difference in platelet changes among the above two groups. The peak of CRP in peripheral blood of AMI patients was positively correlated with the expression of CD41 / CD61 (r = 0.754, P <0.01). Cardiac events in the AMI group (15 patients, including recurrent AMI within a year of follow-up, myocardial revascularization in a rehospitalization hospital, and cardiac death during hospitalization and follow-up) were associated with cardiac events within 1 year of follow-up CD41 / CD61 expression was significantly different (P <0.05). Conclusion: Platelets are activated in patients with AMI, and the degree of activation is related to the cardiac function in patients with AMI. The correlation between CD41 / CD61 activation and inflammatory cytokines, platelet activation and inflammatory cytokines may all play an important role in the progression and prognosis of patients with AMI factor.