摘要
利用抗人活化血小板α颗粒膜蛋白１４０（ＧＭＰ－１４０）特异的单抗ＳＺ－５１和Ｓ＿（１２），研究了１５例接受溶栓和１５例接受抗凝治疗的急性心肌梗塞（ＡＭＩ）患者的血小板活化和破坏程度，并做了相应的体外试验，同时也观察了两组患者的临床指标和血清心肌酶的变化。结果表明：ＡＭＩ患者治疗前，血小板膜表面ＧＭＰ－１４０分子数及血浆内ＧＭＰ－１４０浓度均明显增高。血小板膜表面ＧＭＰ－１４Ｏ分子数于治疗后第１天开始下降，第７天恢复至基础水平；血浆内ＧＭＰ－４０浓度于治疗后第１天达高峰，第２天开始下降，第３天恢复至基础水平。溶栓组和抗凝组治疗前后各时间点以上两指标的变化差异无显著性。溶栓剂尿激酶（ＵＫ）与血小板在体外单独作用，未发现它可以激活血小板及抑制血小板的活性。与抗凝组比较，溶栓组冠脉再通率提高，ＣＫ及ＣＫ－ＭＢ峰值前移，左室射血分数（ＬＶＥＦ）明显改善，心电图ＳＴ段回降率及胸痛缓解率增高，梗塞并发症（室颤、左心衰、心绞痛）有下降趋势。ＧＭＰ－１４０与心肌酶的相关分析表明两者呈正相关，且差异有显著性。
he degree of platelet activation and damage in 15 cases with acute myocardial infarction (AMI)re- ceiving thrombolytic therapy and 15 cases with AMI receiving anticoagulant therapy were studied in vivo and in vitro by using specific monoclon6l antibOdies(SZ-51 & S12)against alpha-granule membrane pro- tein 140 (GMP-140).Clinical indexes and myocardial enzyme changes in the two groups of patients were also observed.The results showed that the number of GMP-140 molecules on platelet surface and the con- centratiOn of GMP-140 in plasma were increased before treatment.The number of GMP-140 molecules on platelet surface began to decrease on the lst day and returned to baseline on the 7th day after treatment. The concentration of GMP-140 in plasma reached a peak on the lst day,began to fall on the 2nd day and returned to baseline on the 3rd day after treatment.There were no significant differences in the dynamic changes of number of GMP-140 molecules on plateiet surface and the concentration of GMP-140 in plasma between groups of thrombolytic therapy and anticoagulant therapy.In vitro experiment showed that the thrombolvtic medicine urokinase neither activated platelets nor inhibited platelet activation induced by thrombin,Significantly greater reperfusion rate and earlier appearence of CK and CK-MB peaks were found in the thrombolytic than in the anticoaguILqnt group.LVEF determined by echocardiography,rate of return of ST segments to ba,eline and alleviation rate of chest pain were significantly greater and complica tions of AMI(ventricular fibrillation,left ventricular failure and angina)were less in the group receiving thrombolytic therapy,Correlation analysis between GMP-140 and myocardial enzymes showed definite positive correlation.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1995年第4期253-255,共3页
Chinese Journal of Internal Medicine
