Kolarov P, Tschoepe D, Nieuwenhuis H K, Gries F A, Strauer B, Schultheiss H P
Diabetes Research Institute, Heinrich Heine University, Duesseldorf, Germany.
Eur Heart J. 1996 Aug;17(8):1216-22. doi: 10.1093/oxfordjournals.eurheartj.a015039.
Percutaneous transluminal coronary angioplasty (PTCA) with its various manipulations could create a dangerous, sudden haemostatic response. This study was performed to investigate PTCA-induced periprocedural changes in platelet activation and its consequences.
Twenty-five consecutive patients admitted for elective PTCA were preclassified as having or not having circulating activated platelets. Blood samples were taken for platelet activation marker analysis before, six times during and 2 h after PTCA. Intravascular platelet activation was analysed by flow cytometry to measure activation-dependent surface markers thrombospondin, P-selectin (CD62) and lysosomal GP53 (CD63).
PTCA was associated with a significant reduction of peripheral platelet count. The initiation of the PTCA procedure led to a significant loss of more than 50% of the degranulated, activated platelets. After PTCA, the number of degranulated, activated platelets uniformly increased.
We conclude that PTCA can induce consumption, particularly of preactivated platelets, and lead to sustained platelet activation after the procedure. This might explain why preactivated patients are at increased risk of suffering periprocedural ischaemic events and why increased thrombogenicity favours acute flow disruption and the progression of coronary stenosis at the lesion site.
经皮腔内冠状动脉成形术（PTCA）及其各种操作可能引发危险的、突然的止血反应。本研究旨在调查PTCA诱导的围手术期血小板激活变化及其后果。
连续入选25例择期行PTCA的患者，预先分为循环中存在或不存在活化血小板的患者。在PTCA前、术中6次及术后2小时采集血样进行血小板激活标志物分析。通过流式细胞术分析血管内血小板激活情况，以测量依赖激活的表面标志物血小板反应蛋白、P-选择素（CD62）和溶酶体糖蛋白53（CD63）。
PTCA与外周血小板计数显著降低相关。PTCA操作开始导致超过50%的脱颗粒活化血小板显著丢失。PTCA后，脱颗粒活化血小板数量一致增加。
我们得出结论，PTCA可诱导消耗，尤其是预激活血小板的消耗，并导致术后血小板持续激活。这可能解释了为什么预激活患者发生围手术期缺血事件的风险增加，以及为什么血栓形成性增加有利于病变部位急性血流中断和冠状动脉狭窄进展。
