摘要
目的 观察急性心肌梗死 (AMI)患者脂蛋白的 (a) [LP(a) ]与凝血和纤溶功能的关系以及尿激酶溶栓治疗对其影响。方法 采用酶联免疫吸附双抗体夹心法 (ELISA)检测 2 0例AMI、30例稳定型心绞痛 (SAP)、8例不稳定型心绞痛(UAP)患者和 2 0例健康人以及AMI溶栓后的血清LP(a)、血浆D -二聚体 (DD)、纤维蛋白单体 (FM)和组织型纤溶酶原激活剂(t-PA)浓度。结果 AMI、UAP和SAP患者的LP(a)、DD和FM较对照组明显增高 ,而t-PA明显降低 (P <0 0 1) ;AMI合并心衰、心源性休克和严重心律失常以及梗死面积较大者的LP(a)、DD和FM均显著增高 ,t-PA下降。AMI溶栓后梗死相关动脉(IRA)再通者的FM和LP(a)明显下降 ,DD和t-PA在早期明显升高。未溶栓组的LP(a)与DD呈正相关 (r=0 47,P <0 0 1) ,与t-PA呈负相关 (r=0 5 2 ,P <0 0 1)。溶栓未通组的LP(a)与DD呈正相关 (r=0 38,P <0 0 1)。溶栓再通组的LP(a)与t-PA呈正相关 (r=0 37,P <0 0 5 )。结论 冠心病患者 ,特别是急性心肌缺血患者体内存在凝血活性增强 ,纤溶活性下降 ,与升高的LP(a)一起可加重其病理生理过程。尿激酶 (UK)溶栓治疗对AMI患者可产生有利的影响 ,能在一定程度上纠正凝血和纤溶功能紊乱 ;AMI溶栓后早期出现DD和t-PA浓度明显升高可能提示IRA再通。
Objective To observe the relationship between lipoprotein(a) and the activity of coagulation and fibrinolysis and the effects of urokinase thrombolysis on them in acute myocardial infarction.Methods The levels of serum LP(a),plasma D-dimer(DD),fibrin monomer(FM) and tissue-type plasminogen activator(t-PA) were determined by enzyme-linked immunosorbent assay(ELISA) in 20 patients with acute myocardial infarction (AMI),8 unstable angina pectoris(UAP) 30 stable angina pectoris(SAP) and 20 normal controls.Results The levels of LP(a),DD and FM were significantly higher,whereas the t-PA was markedly reduced ( P <0 01) in patients with AMI,UAP and SAP than those in controls.Moreover,LP(a),DD and FM increased,but t-PA reduced significantly in AMI patients with heart failure,cardiogenic shock,severe arrhythmia and extensive infartion.LP(a) correlated positively with DD( r =0 47, P <0 01),and negatively with t-PA( r =-0 52, P <0 01) in AMI patients after urokinase(UK) treatment,FM and LP(a) dropped,DD and t-PA rised evidently in the early stage of successful reperfusion.Conclusions There are increased coagulation,decreased fibrinolysis activity in CHD patients,especially in those with acute ischemic coronary syndrome,combined with increased LP(a),these may aggravate pathophysiological process of CHD.UK treatment may be beneficial in AMI patients for correcting the disorders of coagulation and fibrinolysis.The significant increase of DD and t-PA concentrations in the early stage after UK thrombolysis may imply successful reperfusion. [
出处
《中国急救医学》
CSCD
北大核心
2000年第3期136-139,共4页
Chinese Journal of Critical Care Medicine
