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目的 探讨冠心病患者血小板凝聚力的昼夜变化节律以及 β 受体阻滞剂对其的影响。方法 共入选 4 6例冠心病患者 ,其中男性 33例 ,女性 13例 ;年龄 32～ 6 7(49± 9)岁。在常规基础治疗2周后 ,抽采血样 (4h一次 ,2 4h内共 6次 )测定其血小板聚集力。然后给患者服用美托洛尔 (2 5mg ,每日 2次 ) ,2周后重复测定血小板聚集功能。应用余弦拟合法分析其昼夜分布曲线的近日节律。结果 统计分析表明 ,美托洛尔治疗前后患者血小板凝聚力的昼夜分布均表现为近日节律。美托洛尔治疗对血小板凝聚力的 2 4h中值 (6 4 0 6 5 3对 6 1 6 6 3 0 ,P >0 0 5 )与峰值相位 (10 1° 98°对 115° 116°,P >0 0 5 )无显著影响 ,但显著降低了其峰值水平 (振幅 10 0 9 9对 4 0 5 2 ,P <0 0 0 1)。结论 冠心病患者血小板凝聚力存在近日节律 ,美托洛尔治疗对其昼夜平均水平无显著影响 ,但可有效抑制清晨觉醒后数小时内血小板凝聚性的迅速升高现象 ,可能有助于降低这一时段内缺血性心脏事件发作的危险性。
Objective To investigate the circadian rhythm of platelet cohesion in patients with coronary heart disease and the effect of β-blocker on it. Methods A total of 46 patients with coronary heart disease were enrolled, including 33 males and 13 females, ranging in age from 32 to 67 (49 ± 9) years. After 2 weeks of routine basic treatment, blood samples (once in 4 hours and 6 times in 24 hours) were collected to measure platelet aggregation. Metoprolol was then administered to patients (25 mg twice daily) and platelet aggregation was measured after two weeks. Applying cosine fitting method to analyze the diurnal rhythm of its diurnal distribution curve. Results Statistical analysis showed that day and night platelet cohesion in patients with metoprolol before and after treatment showed the rhythm of the recent rhythm. Median of platelet cohesion 24 h median (6 4 0 6 5 3 vs 6 1 6 6 3 0, P 0 05) and peak phase (10 1 ° 98 ° vs 115 ° 116 °, P > 0 0 5), but significantly reduced their peak levels (amplitude 10 9 9 vs 4 0 5 2, P 0 01). Conclusion There is a recent rhythm of platelet cohesion in patients with coronary heart disease. Metoprolol has no significant effect on the average day-night level, but it can effectively reduce the rapid increase of platelet cohesion within a few hours after wakeful morning awakening. Risk of episodes of ischemic heart attack during a time period.