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目的观察急性脑梗死患者血小板-白细胞聚集体(PLA)的变化以及阿司匹林和氯吡格雷对其的影响。方法对急性脑梗死和对照组患者血小板聚集率(PAR)、可溶性 P 选择素(sP-sel)、C-反应蛋白(CRP)和 PLA 进行检测。同时将急性脑梗死患者随机分为阿司匹林组和氯吡格雷组,观察两组患者治疗前后斯堪的纳维亚神经卒中量表(SNSS)评分、PAR、sP-sel、CRP 和 PLA 的变化。结果急性脑梗死患者血小板单核细胞聚集体(PMA)显著高于对照组(P<0.001);PMA 水平与 PAR、sP-sel、CRP、血糖、胆固醇和纤维蛋白原正相关(P<0.05);与 SNSS 评分负相关(P<0.05)。脑梗死患者治疗后 PMA、PAR 明显下降(P≤0.001),且治疗后氯吡格雷组 PMA 和 PAR(ADP)降低较阿司匹林组更明显(P<0.05),但 PAR(AA)两组间差异无统计学意义;sP-sel 在氯吡格雷组治疗后显著下降(P<0.001)。结论急性脑梗死患者反映血小板活化的敏感指标 PMA 明显增高,阿司匹林和氯吡格雷可以降低 PMA 水平,其中氯吡格雷作用较阿司匹林更为明显。
Objective To investigate the changes of platelet-leukocyte aggregates (PLA) in patients with acute cerebral infarction and the effects of aspirin and clopidogrel on them. Methods The platelet aggregation rate (PAR), soluble P-selectin (sP-sel), C-reactive protein (CRP) and PLA in patients with acute cerebral infarction and control group were measured. At the same time, patients with acute cerebral infarction were randomly divided into aspirin group and clopidogrel group. The scores of Scandinavian Stroke Scale (SNSS), changes of PAR, sP-sel, CRP and PLA before and after treatment were observed in both groups. Results The levels of platelet monocyte aggregates (PMA) in patients with acute cerebral infarction were significantly higher than those in the control group (P <0.001). The levels of PMA were positively correlated with PAR, sP-sel, CRP, blood glucose, cholesterol and fibrinogen ; Negatively correlated with SNSS score (P <0.05). The levels of PMA and PAR decreased significantly in patients with cerebral infarction (P≤0.001), and the reduction of PMA and PAR (ADP) in clopidogrel group was more obvious than that in aspirin group (P <0.05) after treatment, but the difference between PAR (AA) No statistical significance; sP-sel significantly decreased after clopidogrel treatment (P <0.001). Conclusions PMA, a sensitive indicator of platelet activation, is significantly increased in patients with acute cerebral infarction. Aspirin and clopidogrel can reduce the level of PMA, and the effect of clopidogrel is more obvious than that of aspirin.