中药对冠心病的多靶点治疗PPT.ppt

Aggregation of platelets into a thrombus Platelets Endothelial cells Subendothelial space Platelets adhering to subendothelial space Platelet thrombus 血小板聚集和活化 Normal platelets in flowing blood Platelets adhering to damaged endothelium and undergoing activation Aspirin NSAIDs ADP receptor COX-1 TXA2 GPIIb - IIIa Signalling pathways ADP receptor antagonists Clopidogrel THROMBIN receptor Thrombin inhibitors II Fibrinogen Phosphodiesterase inhibitors dipyridamole Fibrinogen Receptor Antagonists AA Targets for anti-platelet therapy Platelet-fibrinogen interaction Platelet aggregation Blood vessel wall Platelet Platelet IIb/IIIa Fibrinogen Ib receptor Site of injury Platelet adhesion IIb/IIIa receptor blockers Ib Ib Ib Ib 阿司匹林作用机理 ASA使得环氧化酶 发生乙酰化 阿司匹林抵抗定义 应用阿司匹林作为心脑血管疾病的二级预防，阿司匹林未完全预防栓塞及其它缺血事件 服用阿司匹林患者体外试验血小板聚集功能未受到抑制或出血时间未延长 （引自PatronoＣ,et al.Chest ,1998,114:470-488s.） Prevalence of ASA Resistance Gum PA et al. Am J Cardiol 2001;88:230-235 ASA-R: mean aggregation ≥70% with μM 10 ADP ≥20% with 0.5 mg/ml AA 325 patients with stable CVD taking ASA 325 mg 7days ASA Resistance and Clinical Outcome in CVD Patients Gum PA, et al. J Am Coll Cardiol 2003; 41:961-965 ASA-R: mean aggregation ≥70% with 10 μM ADP ≥20% with 0.5 mg/ml AA 326 CVD patients on ASA 325 mg 7 days p=0.03 ? Aspirin Resistant Patient Management Increase aspirin dose Eliminate interfering substances (NSAIDs) Use other anti-platelet medications such as clopidogrel to prevent recurrent ischemic events Educate patient on importance of compliance Conclusions ASA use associated with 23% reduction in the odds of vascular events Beneficial anti-thrombotic effect of ASA mediated by irreversible acetylation of COX-1 ASA resistance 5-60% ASA resistance associated with increased risk of major adverse cardiovascular events 2003年11月-2005年1月 从成都、石家庄、沈阳、昆明等地 筛选出阿司匹林抵抗患者 开展复方丹参滴丸干预作用的研究 本组筛选出 阿司匹林抵抗患者86名 （男57名，女29名， 年龄70.9±10.9岁） 入组标准 1、连续服用阿司匹林≥75mg/天、≤325m