Wilczyński Mirosław, Krejca Michał, Stepinski Piotr, Rozalski Marcin, Golanski Jacek
Department of Cardiac Surgery, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Lodz, Poland.
Department of Haemostasis and Haemostatic Disorders, Medical University of Lodz, Lodz, Poland.
Arch Med Sci. 2019 Dec 12;19(2):392-400. doi: 10.5114/aoms.2019.90470. eCollection 2023.
Despite therapy, patients operated using a cardiopulmonary bypass demonstrate increased platelet aggregation, which rebounds to above preoperative levels. The aim of the study was to test the interaction between platelet reactivity/activation and selected inflammatory markers in the post-operative period.
In total, 103 patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who were not eligible for percutaneous coronary interventions (PCI), and required urgent revascularization, were included. Platelet reactivity was measured using the PFA-100 platelet analyser, multiple electrode aggregometry, and was expressed as a novel platelet reactivity score (PRS). Patients were divided using their PRS scores into high platelet relativity or low platelet reactivity subgroups (HPR or LPR). Platelet basal activation was measured using immunoassays for soluble P-selectin and soluble CD40L. We measured high-sensitivity C-reactive protein (CRP), and used immunoassays for tumour necrosis factor α (TNF-α) and interleukin 6 (IL-6) as inflammation markers.
Significant differences between HPR and LPR groups were found for CRP (mg/l): 81.5 vs. 44.6, < 0.02; and TNF-α (pg/l): 3.51 vs. 2.37, < 0.02. A significant association was found between CRP, TNF-α, IL-6 and platelet reactivity (platelet reactivity score). Cohen's k showed: CRP = 0.49, < 0.0001, TNF-α = 0.37, < 0.002. Perioperative myocardial infarction and rhythm disturbances occurred more frequently in the high platelet reactivity group: 7 (16.3%) vs. 2 (3.3%), < 0.04, and 9 (20.9%) vs. 4 (6.7%), < 0.04, respectively.
Inflammatory parameters CRP and TNF-α are strongly associated with platelet reactivity (expressed as PRS) in cardiopulmonary bypass graft patients. Platelet hyperreactivity in the early post-operative period combined with a systemic inflammatory state correlates with a higher risk of post-operative rhythm disturbances and myocardial infarction.
尽管进行了治疗，但接受体外循环手术的患者血小板聚集增加，且会反弹至术前水平以上。本研究的目的是测试术后血小板反应性/活化与选定炎症标志物之间的相互作用。
总共纳入了103例不符合经皮冠状动脉介入治疗（PCI）条件且需要紧急血运重建的非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者。使用PFA-100血小板分析仪、多电极聚集测定法测量血小板反应性，并表示为一种新的血小板反应性评分（PRS）。根据PRS评分将患者分为高血小板反应性或低血小板反应性亚组（HPR或LPR）。使用可溶性P-选择素和可溶性CD40L的免疫测定法测量血小板基础活化。我们测量了高敏C反应蛋白（CRP），并使用肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）的免疫测定法作为炎症标志物。
HPR组和LPR组在CRP（mg/l）方面存在显著差异：81.5对44.6，P<0.02；TNF-α（pg/l）方面：3.51对2.37，P<0.02。发现CRP、TNF-α、IL-6与血小板反应性（血小板反应性评分）之间存在显著关联。科恩kappa系数显示：CRP=0.49，P<0.0001，TNF-α=0.37，P<0.002。高血小板反应性组围手术期心肌梗死和心律失常的发生率更高：分别为7例（16.3%）对2例（3.3%），P<0.04，以及9例（20.9%）对4例（6.7%），P<0.04。
炎症参数CRP和TNF-α与体外循环搭桥患者的血小板反应性（以PRS表示）密切相关。术后早期血小板高反应性与全身炎症状态相结合，与术后心律失常和心肌梗死的较高风险相关。
