Gurbel P A, Serebruany V L, Shustov A R, Dalesandro M, Gumbs C I, Grablutz L B, Bahr R D, Ohman E M, Topol E J
Center for Thrombosis Research, Sinai Hospital, Baltimore, MD 21215, USA.
Coron Artery Dis. 1998;9(7):451-6. doi: 10.1097/00019501-199809070-00008.
Platelets play a pivotal role in the pathogenesis of acute myocardial infarction and their activation can cause thrombolysis to fail.
Baseline aggregation of platelets and expression of major surface receptors measured by flow cytometry were compared with clinical outcome after thrombolysis for 23 patients enrolled in the GUSTO-III trial.
Failure to reperfuse (n = 3) and recurrent ischemia (n = 2) were observed in five patients who subsequently underwent emergency angioplasty. These patients were treated later in their course of disease than were the 18 patients who were successfully reperfused and remained free of recurrent ischemia. Greater than normal expression of platelet P-selectin (33.7 +/- 1.1 versus 28.1 +/- 1.9, P = 0.01) and expression of platelet--endothelial cell adhesion molecule-1 (PECAM-1; (57.1 +/- 2.3 versus 50.2 +/- 2.8, P = 0.02) were observed in members of the group with recurrent ischemia or failed reperfusion.
Greater than normal baseline expression of P-selectin and PECAM-1 platelet receptors was correlated to delayed and unsuccessful coronary thrombolysis among patients presenting with acute myocardial infarction.
血小板在急性心肌梗死的发病机制中起关键作用，其激活可导致溶栓失败。
对参加GUSTO-III试验的23例患者溶栓后的临床结局与通过流式细胞术测量的血小板基线聚集及主要表面受体表达进行比较。
5例随后接受急诊血管成形术的患者出现再灌注失败（n = 3）和反复缺血（n = 2）。与18例成功再灌注且未出现反复缺血的患者相比，这些患者在病程后期才接受治疗。在反复缺血或再灌注失败组患者中观察到血小板P-选择素表达高于正常（33.7 ± 1.1对28.1 ± 1.9，P = 0.01）以及血小板-内皮细胞黏附分子-1（PECAM-1）表达高于正常（57.1 ± 2.3对50.2 ± 2.8，P = 0.02）。
急性心肌梗死患者中，P-选择素和PECAM-1血小板受体基线表达高于正常与冠状动脉溶栓延迟及失败相关。
