双重抗血小板治疗对急性脑梗死患者血小板活化及聚集的影响

双重抗血小板治疗对急性脑梗死患者血小板

活化及聚集的影响

作者：陈孝东王光胜曹勇军王元伟杨春伍胡礼仪

【摘要】目的观察急性脑梗死患者血小板CD62p表达及血小板聚集的变化，并探讨双重抗血小板治疗对其的影响。方法将60例急性脑梗死患者随机分为阿司匹林治疗组（A组）和阿司匹林＋银杏达莫注射液治疗组（B组），每组各30例。采用流式细胞技术，于发病次日及治疗2周后对血小板CD62p的表达进行检测，并观察2组患者治疗前后Scandinavian卒中量表（SNSS）评分、血小板聚集率（PAR）的变化。结果与治疗前比较，2组治疗后PAR(ADP) 、PAR(AA)、 CD62p 均显著降低，差异有统计学意义（P＜0.01）；2组治疗后SNSS评分均高于治疗前，差异有统计学意义（P＜0.05）；2组治疗后比较，B组PAR(ADP)、 CD62p低于A组，差异有统计学意义（P＜0.01）。结论与单用阿司匹林相比，阿司匹林联用银杏达莫注射液具有更强的抑制血小板活化及聚集的作用。

【关键词】脑梗死；血小板活化；血小板聚集；阿司匹林；银杏达莫注射液

【Abstract】 Objective To observe the changes of platelet activity (expressed by CD62p) and platelet aggregation rate (PAR) in patients with cerebral infarction, as well as to explore the effects of aspirin combined with Ginkgo leaf extract and dipyridamole injection on the activation and aggregation of platelets. Methods Sixty patients with acute cerebral infarction were randomly divided into two groups：group A（30 cases）, treated with aspirin（0.1g/d）；group B（30 cases）,treated with aspirin（0.1g/d） and Ginkgo leaf extract and dipyridamole injection. The level of CD62p expression (using flow cytometry method) and PAR were measured before and after treatment. Scandinavian stroke score (SNSS) was introduced to evaluate the clinical efficiency. Results After treatment, the percentage of PAR(ADP), PAR(AA) and CD62p were decreased in both groups（P ＜0.01）. The score of SNSS was significantly increased in both groups after treatment, but there was no difference in score of SNSS between group A and group B either before or after treatment. The percentage of PAR(ADP) and CD62p in group B were lower than that in group A after treatment (P<0.01). Conclusion The activation and aggregation of platelet in patients with cerebral infarction may be significantly suppressed by aspirin combined with Ginkgo leaf extract and dipyridamole injection, which is

better than the effect of aspirin alone.

【Key words】 Cerebral infarction; Platelet activation; Platelet aggregation; Aspirin; Ginkgo leaf extract and dipyridamole injection

血小板活化是动脉粥样硬化性脑梗死的重要的病理生理过程，血小板的血液流变学特性及其黏附、释放和聚集活性在血栓形成中起着重要作用［1］。抗血小板治疗是脑梗死急性期及二级预防的基石。在二级预防方面，大规模的研究显示，阿司匹林联用双嘧达莫效果优于单用阿司匹林［23］。本研究旨在观察阿司匹林联用银杏达莫注射液对急性脑梗死患者血小板CD62p（P选择素）表达及血小板聚集的影响。

1 对象与方法

1.1 对象选择200701～200801在我科住院的急性脑梗死患者60例为研究对象。入选标准：(1)符合全国第四届脑血管病学术会议修订的诊断标准；(2)首次发病，起病24h以内；(3)表现为颈内动脉供血区局灶性神经功能缺失的症状和体征；(4)发病6h后经头颅MRI扫描证实为脑梗死；(5)患者或家属知情同意。排除标准：(1)感染、肿瘤、肝肾疾病、自身免疫性疾病、心血管病和下肢动静脉血

栓形成等患者；(2)近1月内服用过阿司匹林、潘生丁、氯吡格雷等影响血小板活化药物者；(3)房颤、感染性心内膜炎等引起的脑栓塞患者；

(4)需要溶栓、降纤、抗凝治疗的患者。入选患者又被随机分为阿司匹林治疗组（A组）和阿司匹林＋银杏达莫注射液治疗组（B组），每组各30例。