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目的探讨华法林抗栓治疗对心房颤动(房颤)患者的血小板活化状态的影响。方法选择106例45～80岁的非瓣膜病持续性房颤患者,随机分为两组,分别给予华法林(INR在1.5～2.5)(华法林组)和阿司匹林150mg/d(阿司匹林组)治疗并随访1年。于治疗前、治疗后6和12个月,检查血小板计数和血小板最大聚集率(MAR),测定血浆血小板α颗粒膜糖蛋白-140(GMP-140)、血栓素B2(TXB2)和6-酮-前列腺素F1α(6-k-PGF1α)水平。结果治疗后,华法林组的GMP-140[(31.27±11.47)ng/ml vs (14.08±5.96)ng/ml]和TXB2(112.04pg/ml vs 90.70pg/ml)显著降低,差异均有统计学意义(均P<0.05),阿司匹林组的血小板MAR[(60.54±26.45)% vs (23.29±17.29)%)]、GMP-140[(31.18±9.78)ng/ml vs (13.11±5.35)ng/ml)、TXB2(103.73pg/ml vs 38.79pg/ml)和TXB2/6-k-PGF1α(0.54 vs 0.20)显著降低,差异有统计学意义(均P<0.05)。Pearson相关分析发现,治疗后GMP-140和TXB2的降低幅度与各自治疗前水平成正相关。随访期间无血栓栓塞和严重出血并发症发生。结论华法林对房颤患者的血小板活化有抑制作用,但其作用弱于阿司匹林。
Objective To investigate the effect of warfarin antithrombotic therapy on platelet activation in patients with atrial fibrillation (AF). Methods A total of 106 patients with non-valvular persistent AF who were 45-80 years old were randomly divided into two groups and received warfarin (INR 1.5-2.5) (warfarin) and aspirin 150 mg / d (aspirin ) Treatment and follow-up for 1 year. Before treatment, 6 and 12 months after treatment, platelet count and maximum platelet aggregation (MAR) were measured to determine plasma platelet α-granule membrane glycoprotein-140 (GMP-140), TXB2 and 6- - Prostaglandin F1α (6-k-PGF1α) levels. Results After treatment, GMP-140 [(31.27 ± 11.47) ng / ml vs (14.08 ± 5.96) ng / ml] and TXB2 (112.04 pg / ml vs 90.70 pg / ml) in warfarin group were significantly lower (60.54 ± 26.45)% vs (23.29 ± 17.29)%), GMP-140 [(31.18 ± 9.78) ng / ml vs (13.11 ± 5.35)) in aspirin group (P <0.05) TXB2 (103.73 pg / ml vs 38.79 pg / ml) and TXB2 / 6-k-PGF1α (0.54 vs 0.20), all of which were statistically significant (all P <0.05). Pearson correlation analysis found that the reduction of GMP-140 and TXB2 after treatment was positively correlated with their pretreatment levels. No thromboembolism and severe bleeding complications occurred during follow-up. Conclusion Warfarin can inhibit platelet activation in patients with atrial fibrillation, but its effect is weaker than that of aspirin.