Pedersen Oliver Buchhave, Nissen Peter H, Pasalic Leonardo, Hvas Anne-Mette, Kristensen Steen Dalby, Grove Erik Lerkevang
Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Res Pract Thromb Haemost. 2024 Dec 9;9(1):102652. doi: 10.1016/j.rpth.2024.102652. eCollection 2025 Jan.
Reduced effect of antiplatelet therapy has been reported in patients with ST-segment elevation myocardial infarction (STEMI). This could partly be explained by an increase of highly reactive immature platelets.
To investigate changes in platelet maturity and reactivity after acute STEMI.
Patients diagnosed with STEMI, admitted for primary percutaneous coronary intervention, and treated according to international guidelines, were included. Blood samples were obtained within 24 hours after admission and at 2- to 3-months follow-up. Platelet maturity and reactivity using multicolor flow cytometry with SYTO-13 to categorize platelet maturity, whole blood platelet aggregation, serum thromboxane B2 levels, and standard immature platelet markers (eg, immature platelet count and fraction, and mean platelet volume) were measured.
A total of 44 STEMI patients were included. The reactivity of immature platelets was consistently higher at baseline and at follow-up when compared to the entire platelet population and the mature platelet population (all values < .05). The expression of CD63 (a dense granule marker) in immature platelets was consistently high compared to the entire platelet population and the mature platelet population and did not change from baseline to follow-up ( values > .24). Additionally, a positive significant correlation was found between standard immature platelet markers and the expression of CD63 on platelets both at baseline and follow-up (rho ranging from 0.32 to 0.62, all values < .05).
Immature platelets represent a highly reactive platelet subpopulation crucial for the overall platelet reactivity, partly due to a high expression of dense granules. Despite treatment with loading and maintenance doses of antiplatelet therapy, the reactivity of immature platelets remained high in STEMI patients.
据报道，ST段抬高型心肌梗死（STEMI）患者的抗血小板治疗效果降低。这部分可以通过高反应性未成熟血小板的增加来解释。
研究急性STEMI后血小板成熟度和反应性的变化。
纳入诊断为STEMI、接受直接经皮冠状动脉介入治疗并按照国际指南进行治疗的患者。在入院后24小时内及2至3个月随访时采集血样。使用SYTO-13多色流式细胞术对血小板成熟度进行分类，测量全血血小板聚集、血清血栓素B2水平以及标准未成熟血小板标志物（如未成熟血小板计数和比例、平均血小板体积），以评估血小板成熟度和反应性。
共纳入44例STEMI患者。与整个血小板群体和成熟血小板群体相比，未成熟血小板的反应性在基线和随访时始终较高（所有P值<0.05）。与整个血小板群体和成熟血小板群体相比，未成熟血小板中CD63（致密颗粒标志物）的表达始终较高，且从基线到随访没有变化（P值>.24）。此外，在基线和随访时，标准未成熟血小板标志物与血小板上CD63的表达之间均存在显著正相关（rho范围为0.32至0.62，所有P值<0.05）。
未成熟血小板代表了一个对整体血小板反应性至关重要的高反应性血小板亚群，部分原因是致密颗粒的高表达。尽管给予了负荷剂量和维持剂量的抗血小板治疗，但STEMI患者中未成熟血小板的反应性仍然很高。
