高劑量瑞舒伐他汀對PCI術后患者血小板功能的影響

彭宇程　李志全

【摘要】 目的：研究高劑量瑞舒伐他汀對PCI術后患者血小板功能影響，進一步探討他汀類藥物與血小板功能的關系。方法：92例擇期行PCI術的冠心病患者分為瑞舒伐他汀5 mg組（R5組，n=30）、瑞舒伐他汀20 mg組（R20組，n=31）、阿托伐他汀20 mg組（A20組，n=31），同期行冠脈造影的非冠心病患者30例作為單純冠狀動脈造影組（單純CAG組）。通過流式細胞檢測術，比較術前及術后24 h四組血小板活化標志物CD62P、CD63變化。結果：R5、R20和A20組CD62P百分率術后較術前均有不同程度的升高（P<0.05），單純CAG組術后無明顯升高（P>0.05）。與R20組相比，R5、A20組術后CD62P百分率顯著升高，差異均有統計學意義（P<0.05）；術后R5組CD62P百分率與A20組比較，差異無統計學意義（P>0.05）。術后，R5、A20組CD63百分率明顯高于R20組，差異均有統計學意義（P<0.05）。R5組CD63百分率與A20組比較，差異無統計學意義（P>0.05）；R20組CD63百分率與單純CAG組比較，差異無統計學意義（P>0.05）。結論：血小板活化標志物檢測表明經皮冠脈介入術術后循環外周血小板活性增高，對評估術后患者血小板功能狀態具有積極意義；瑞舒伐他汀具有抑制血小板作用，并隨劑量升高而加強，并且安全有效，PCI術前負荷劑量服用可使患者獲益更多。

【關鍵詞】 瑞舒伐他汀； 經皮冠狀動脈介入治療； CD62P

【Abstract】 Objective：To assess the influence of high dose Rosuvastatin on platelet function in patients after PCI.Method：A total of 92 coronary heart disease（CHD） patients underwent PCI were divided into Rosuvastatin 5 mg group（R5 group，n=30），Rosuvastatin 20 mg group（R20 group，n=31） and Atorvastatin 20 mg（A20 group，n=31），30 non-CHD patients were recruited as the coronary arteriongraphy group（CAG group）.Platelet activation markers CD62P and CD63 of four groups were examined by flow cytometry before operation and 24 hours after operation.Result：The percentage of CD62P in R5 group，R20 group and A20 group were significantly increased after operation（P<0.05），but the percentage of CD62P in CAG group was non-significantly increased（P>0.05）.Compared with the R20 group，the percentage of CD62P in R5 group and A20 group were significantly higher，the differences had statistical significance（P<0.05）；there were no statistical significance in the percentage of CD62P in R5 group and R20 group after operation（P>0.05）.After operation，the percentage of CD63 in R5 group and A20 group were significantly higher than R20 group，the differences had statistical significance（P<0.05）.There was no difference in the percentage in CD63 of R5 group and A20 group（P>0.05）；and there was no difference in the percentage of CD63 in R20 group and CAG group（P>0.05）.Conclusion：The results of platelet activation markers indicate that peripheral platelet is remarkable activated after PCI，which may be a effective method to evaluate platelet function after PCI；Rosuvastatin has an effect to inhibit platelet function，and its dose related，which indicated patients can be benefited from loading doses of Rosuvastatin before PCI.

【Key words】 Rosuvastatin； Percutaneous coronary intervention； CD62P

First-authors address：Jiangmen Central Hospital，Jiangmen 529000，Chinaendprint

doi：10.3969/j.issn.1674-4985.2017.25.001

20多年來的臨床經驗證實[1]，經皮冠狀動脈介入治療（percutaneous coronary intervention，PCI）可有效改善冠脈血流，緩解心肌缺血的癥狀。但在PCI術中，由于器械、導管對血管內膜造成直接損傷和植入異物支架的刺激，造成內皮損傷，可出現術后急性血管閉塞、冠脈微栓塞[2]。他汀類調脂藥物不僅具有調脂、穩定動脈粥樣斑塊的重要作用[3]，還具有一定的抑制血小板作用[4]。他汀類藥物用量是否與抑制血小板活化的程度有關，目前研究資料甚少。因此……