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Eur Heart J:感染HIV的ACS患者接受双联抗血小板治疗后血小板活性会咋样?

2017-01-10 xing.T MedSci原创

相比于未感染HIV的ACS患者,感染HIV的ACS患者血小板活性水平升高,并且对P2Y12抑制剂和阿司匹林有较高的HPR比例。这些结果对HIV感染者复发性缺血性事件风险增加提供了潜在的解释。

近日,心血管领域权威杂志Eur Heart J上发表了一篇研究文章,研究者旨在探讨感染HIV的急性冠状动脉综合征(ACS)患者接受双联抗血小板治疗(DAPT)对其血小板活性的影响。

研究者纳入了80例感染HIV的ACS患者,以及160例在年龄、性别、糖尿病和DAPT治疗(阿司匹林100%,氯吡格雷68%,普拉格雷31%,替卡格雷1%)相匹配的未感染HIV的ACS患者。研究者通过光传输凝集度测定(LTA)、VerifyNow阿司匹林实验(ARU)、血小板P2Y12检测(PRU)和VASP血小板反应指数(VASP-PRI)测量得到对阿司匹林和P2Y12抑制剂反应的残余血小板聚集(RPA),并将其作为评估ACS发生后(>30天)患者血小板反应性的指标。另外,对研究者对高残留血小板反应性(HPR)的患者比例也进行评价。

研究者发现,相比于未感染HIV的ACS患者,感染HIV的ACS患者对P2Y12抑制剂(RPA:23.8±2.7% vs. 15.3±1.3%;P=0.001;PRU:132±10 vs. 107.4±6.6;P=0.04;VASP-PRI:45.2±2.6% vs. 32±2%;P<0.001)和阿司匹林(RPA:3.6±1.5% vs. 0.4±0.1%;P=0.004;ARU: 442±11 vs. 407±5; P=0.002)的血小板反应性更高。感染HIV与血小板反应性增加独立相关,无论使用何种测试方法(RPA:P=0.005;PRU:P<0.001和VASP-PRI:P<0.001),并且对P2Y12抑制剂反应的HPR比例也较高(比值比分别为7.6;P<0.001;2.06;P=0.06;2.91;P=0.004)。在服用阿司匹林的患者中也观察到了类似的结果。蛋白酶抑制剂的使用与血小板反应性增加和高比例的HPR有关。

由此可见,相比于未感染HIV的ACS患者,感染HIV的ACS患者血小板活性水平升高,并且对P2Y12抑制剂和阿司匹林有较高的HPR比例。这些结果对HIV感染者复发性缺血性事件风险增加提供了潜在的解释。

原始出处:

Marie Hauguel-Moreau,et al. Platelet reactivity in human immunodeficiency virusinfected patients on dual antiplatelet therapy for an acute coronary syndrome: the EVERE2ST-HIV study. Eur Heart J.2017. 

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    2017-01-12 yaanren
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    2017-01-12 zhaojie88
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  5. [GetPortalCommentsPageByObjectIdResponse(id=2009521, encodeId=de1e200952191, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Thu Jun 01 22:16:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279145, encodeId=ffa112e91458a, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356150, encodeId=10e5135615062, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515596, encodeId=409d1515596a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562417, encodeId=17bb156241ebf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574975, encodeId=4b2515e49755b, content=<a href='/topic/show?id=52ab188e48' target=_blank style='color:#2F92EE;'>#ACS患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1887, encryptionId=52ab188e48, topicName=ACS患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf9f16042984, createdName=neurosurgeon, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169476, encodeId=3d011694e662, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Wed Jan 11 07:31:55 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
    2017-01-12 slcumt
  6. [GetPortalCommentsPageByObjectIdResponse(id=2009521, encodeId=de1e200952191, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Thu Jun 01 22:16:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279145, encodeId=ffa112e91458a, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356150, encodeId=10e5135615062, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515596, encodeId=409d1515596a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562417, encodeId=17bb156241ebf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574975, encodeId=4b2515e49755b, content=<a href='/topic/show?id=52ab188e48' target=_blank style='color:#2F92EE;'>#ACS患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1887, encryptionId=52ab188e48, topicName=ACS患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf9f16042984, createdName=neurosurgeon, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169476, encodeId=3d011694e662, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Wed Jan 11 07:31:55 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2009521, encodeId=de1e200952191, content=<a href='/topic/show?id=4f133e56590' target=_blank style='color:#2F92EE;'>#双联抗血小板#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37565, encryptionId=4f133e56590, topicName=双联抗血小板)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Thu Jun 01 22:16:00 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279145, encodeId=ffa112e91458a, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356150, encodeId=10e5135615062, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515596, encodeId=409d1515596a1, content=<a href='/topic/show?id=59ab3e5660f' target=_blank style='color:#2F92EE;'>#双联抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37566, encryptionId=59ab3e5660f, topicName=双联抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=af9010842042, createdName=12498bf3m28暂无昵称, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562417, encodeId=17bb156241ebf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574975, encodeId=4b2515e49755b, content=<a href='/topic/show?id=52ab188e48' target=_blank style='color:#2F92EE;'>#ACS患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1887, encryptionId=52ab188e48, topicName=ACS患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf9f16042984, createdName=neurosurgeon, createdTime=Thu Jan 12 11:16:00 CST 2017, time=2017-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=169476, encodeId=3d011694e662, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Wed Jan 11 07:31:55 CST 2017, time=2017-01-11, status=1, ipAttribution=)]
    2017-01-11 忠诚向上

    好好学习

    0

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