梗塞前心绞痛对ST段抬高心肌梗死患者经皮冠状动脉介入术治后血小板活性的影响

目的：探讨梗塞前心绞痛对ST段抬高心肌梗死患者血小板活性的影响。方法：选取2015年8月至2017年8月期间在我院接受直接经皮冠状动脉介入术治疗的急性ST段抬高心肌梗死首次发作患者223名，根据是否发生梗塞前心绞痛分入PIA组和非PIA组，采用流式细胞仪对急性期住院时和一个月后随访时接受和未接受二磷酸腺苷活化的血小板活性进行评估，测定单核细胞-血小板聚集率以及血小板门内糖蛋白IIb/IIIa（CD41）和纤维蛋白原受体（PAC-1）的表达率。结果：在急性期，PIA组患者未接受和接受二磷酸腺苷活化的样本单核细胞-血小板聚集率（分别为22.01%±1.6%和28.51±2.83）以及CD41（分别为158.20±25.5和197.62±34.2）和PAC-1（分别为6.93±2.29和10.38±2.48）平均荧光密度显著低于非PIA组（单核细胞-血小板聚集率分别为26.22±4.20和32.63±4.50，CD41分别为175.42±20.21和240.34±70.70，PAC-1分别为9.74±3.10和15.24±3.73），所有P值均小于0.05。一个月后随访期上述变量两组间无显著差异。结论：首次STEMI发作前出现PIA的患者血小板活性低于未出现PIA的患者。

Effect?of?pre-infarction?angina?pectoris?on?platelet?activation?after?percutaneous?coronary?intervention?in?patients?with?ST-segment?elevation?myocardial?infarction

To investigate the effect of pre-infarction angina on platelet activity in patients with ST-segment elevation myocardial infarction. Methods: Patients with acute ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention in our hospital from August 2015 to August 2017 were selected and divided into PIA group and non-PIA group according to whether pre-infarction angina (PIA) was or not. Flow cytometry was used to evaluate the activity of platelets stimulated with or without adenosine diphosphate during hospitalization and follow-up after one month, and the monocyte-platelet aggregation (MPA) and platelet glycoprotein IIb/IIIa (CD41) and fibrinogen receptor (PAC-1) expression rates were determined. Results: In the acute phase, for patients in the PIA group with or without adenosine diphosphate stimulation, the monocyte-platelet aggregation rates (22.01%±1.6% and 28.51%±2.83%, respectively) and mean fluorescence density of CD41 (158.20±25.5 and 197.62±34.2, respectively) and PAC-1 (6.93±2.29 and 10.38±2.48 respectively) was significantly lower than non-PIA group (monocyte-platelet aggregation rates were 26.22±4.20 and 32.63±4.50, respectively, CD41 were 175.42±20.21 and 240.34±70.70, PAC-1 were 9.74±3.10 and 15.24±3.73, respectively, all P values were less than 0.05. There were no significant differences between the two groups in follow-up period. Conclusion: The platelet activity in patients with PIA prior to the first STEMI episode was lower than in patients without PIA