氯吡格雷对冠心病患者血清血管扩张刺激磷蛋白磷酸化水平的影响

摘要

Objective To evaluate the changes of platelet activity before and after anti-platelet treatment in pa⁃tients with coronary heart disease, and their responsiveness to clopidogrel through detecting the phosphorylation levels of va⁃sodilator stimulated phosphoprotein (VASP). Methods Twenty-eight cases of healthy people were selected as control group . Patients with chronic stable angina pectoris (CSA, n=95) were randomly divided into A (48 cases) group and B (47 cases) group,and were given clopidogrel 75 mg/d or 150 mg/d respectively;Patients with non ST segment elevation acute coronary syndrome (NST-ACS, n=67) were all given 300 mg loading dose of clopidogrel at the first time, then randomly divid⁃ed into C (33 cases) group and D (34 cases) group, and given clopidogrel 75 mg/d and 150 mg/d respectively. Blood were tak⁃en to examine the phosphorylation levels of serum VASP by ELISA before taking clopidogrel, at time point of loading dose and the fifth day of clopidogrel administration . Results Before treatment, phosphorylation levels of serum VASP were low⁃er in A, B, C, D groups than those in the normal control group(P<0.05). After treatment of clopidogrel for 5 days: ① In group A and group B ,phosphorylation levels of serum VASP did not change compared to that before treatment (P>0.05).②In group C and group D, phosphorylation levels of serum VASP were significantly increased at loading dose and the fifth day of clopidogrel administration than those before treatment (P<0.05), but there were no significant differences in phosphory⁃lation level of VASP was lower group between group C and group D after serum treatment (P > 0.05). Conclusion The phosphorylation level of serum VASP was lower in patients with coronary heart disease than that in normal control group. Clopidogrel can improve the phosphorylation level of serum VASP in NST-ACS patients .%目的：通过检测血管扩张刺激磷蛋白(VASP)磷酸化水平，评价冠心病患者抗血小板聚集治疗前后血小板活性的变化和对氯吡格雷的反应性。方法选取正常对照组28例，不予药物干预；慢性稳定型心绞痛（CSA）95例，将其随机分为A（48例）、B（47例）组，分别给予氯吡格雷75 mg/d、150 mg/d；非ST段抬高型急性冠脉综合征（NST-ACS）67例，首次均给予300 mg负荷量氯吡格雷，此后随机分为C（33例）、D（34例）组，分别序贯给予氯吡格雷75 mg/d、150 mg/d。分别于服用氯吡格雷前、服用负荷剂量氯吡格雷24 h、服用氯吡格雷第5天，取肘静脉血用ELISA法测定血清VASP磷酸化水平。结果服药前，A、B、C、D组血清VASP磷酸化水平均低于正常对照组（P＜0.05）。服药后5 d：（1）A、B组血清VASP磷酸化水平较服药前无明显变化（P＞0.05）；（2）C、D组服用负荷量氯吡格雷24 h及服用维持量第5天血清VASP磷酸化水平均较服药前明显升高（均P＜0.05），C、D组服药后两组间血清VASP磷酸化水平变化差异无统计学意义。结论冠心病患者血清VASP磷酸化水平低于正常对照组，氯吡格雷可提高非ST段抬高型急性冠脉综合征患者血清VASP磷酸化水平。