Kajiwara I, Ogawa H, Soejima H, Takazoe K, Miyamoto S, Sakamoto T, Yoshimura M, Kugiyama K, Yasue H
Department of Cardiovascular Medicine, Kumamoto University School of Medicine, 1-1-1 Honjo, 8608556, Kumamoto, Japan.
Thromb Res. 2001 Feb 1;101(3):109-18. doi: 10.1016/s0049-3848(00)00390-x.
Platelet activation plays a pivotal role in the pathogenesis of acute coronary syndromes. This study was designed to evaluate the platelet aggregability in patients with unstable angina using a new aggregometer with laser-light scattering. We also examined whether there was a relationship between these platelet aggregabilities and unfavorable outcome during in-hospital stay. We measured platelet aggregability, in particular small-sized platelet aggregates in 31 patients with unstable angina, 31 patients with stable exertional angina, and 30 patients with chest pain syndrome. The patients with unstable angina were divided into two groups by their cardiac events during in-hospital stay, cardiac events (+)(n=11) group and cardiac events (-)(n=20) group. On admission, the number of small-sized platelet aggregates (V) was higher in patients with unstable angina (3.0+/-0.5x10(4)) than in those with stable exertional angina (1.4+/-0.3x10(4), P=.017) and chest pain syndrome (0.7+/-0.2x10(4), P=.0003). The number of small-sized platelet aggregates was higher in the cardiac events (+) group than in the cardiac events (-) group (5.5+/-0.9x10(4) vs. 1.6+/-0.4x10(4), P=.0001). A previous study elucidated that small-sized platelet aggregates ultimately developed into medium-sized and large-sized aggregates as platelet aggregation proceeds. Therefore, the production of small-sized platelet aggregates is more sensitive for hyperaggregability. Furthermore, the production of small-sized platelet aggregates increased significantly in patients with unstable angina than in those with stable exertional angina and chest pain syndrome. These findings suggest that a tendency toward thrombus formation increases markedly in patients with unstable angina and increased number of small-sized platelet aggregates on admission predicts poor prognosis during in-hospital stay in patients with unstable angina.
血小板活化在急性冠状动脉综合征的发病机制中起关键作用。本研究旨在使用一种新型激光散射血小板聚集仪评估不稳定型心绞痛患者的血小板聚集性。我们还研究了这些血小板聚集性与住院期间不良结局之间是否存在关联。我们测量了31例不稳定型心绞痛患者、31例稳定劳力型心绞痛患者和30例胸痛综合征患者的血小板聚集性，特别是小尺寸血小板聚集体。不稳定型心绞痛患者根据住院期间的心脏事件分为两组，心脏事件阳性（n = 11）组和心脏事件阴性（n = 20）组。入院时，不稳定型心绞痛患者的小尺寸血小板聚集体数量（V）（3.0±0.5x10⁴）高于稳定劳力型心绞痛患者（1.4±0.3x10⁴，P = 0.017）和胸痛综合征患者（0.7±0.2x10⁴，P = 0.0003）。心脏事件阳性组的小尺寸血小板聚集体数量高于心脏事件阴性组（5.5±0.9x10⁴对1.6±0.4x10⁴，P = 0.0001）。先前的一项研究表明，随着血小板聚集的进行，小尺寸血小板聚集体最终会发展为中尺寸和大尺寸聚集体。因此，小尺寸血小板聚集体的产生对高聚集性更敏感。此外，不稳定型心绞痛患者的小尺寸血小板聚集体产生显著高于稳定劳力型心绞痛患者和胸痛综合征患者。这些发现表明，不稳定型心绞痛患者血栓形成倾向明显增加，入院时小尺寸血小板聚集体数量增加预示着不稳定型心绞痛患者住院期间预后不良。
