急性冠脉综合征患者早期纤溶活性与血小板活性检测

Study on the relationship between fibrinolytic activity and the activity of platelet in patients with early acute coronary syndrome

目的 :探讨急性冠脉综合征 (ACS)患者早期纤溶活性及血小板活性的动态变化规律及其相关性。方法 :选择 4 9例非溶栓的非Q波型ACS患者 ,分别于发病后 1d、2d、3d、7d及 14d采集空腹静脉血 ,用发色底物法检测组织纤溶酶原激活剂 (tPA)及组织纤溶酶原激活剂抑制剂 1(PAⅠ 1)的活性 ,同时用酶联免疫吸附法测量血小板GPⅡb、Ⅲa的含量。以 32例体检正常者为对照。结果 :与对照组比较 ,ACS患者中tPA活性降低 ,PAI 1活性升高(P均 <0 .0 1) ,血小板GPⅡb、Ⅲa含量升高 (P <0 .0 1)。ACS组tPA活性与PAI 1活性及血小板GPⅡb、GPⅢa呈负相关 (r分别为 - 0 .6 6 0 7,- 0 .6 315 ,- 0 .5 72 8,P均 <0 .0 1) ;血浆PAI 1活性与GPⅡb、GPⅢa呈正相关 (r分别为 0 .6 90 1,0 .712 1,P均 <0 .0 1)。结论 :非Q波型ACS患者早期纤溶活性明显下降 ,血小板活性异常升高 ,2者存在相关性。监测tPA、PAI 1活性和GPⅡb、Ⅲa含量有助于ACS的早期治疗。

Aim: To investigate the relationship between fibrinolytic activity and the activity of platelet in patients with early acute coronary syndrome(ACS) without Q wave. Methods: A total of 49 ACS patients without Q wave that were not treated with thrombocytolysis were selected and 32 normal subjects were chosen as controls. Venous blood samples were obtained immediately before the administrations, as well as at the second, third, seventh and fourteenth day after the administration. Plasma levels of tissue plasminogen activator(tPA)and its inhibitor-1(PAI-1)activities were detected by spectrophotemetometric assay. Plasma concentrations of platelet glycopotein IIb and Ⅲa(GPⅡb,Ⅲa)were measured by enzyme linked immunosorbent assay(ELISA). Results: The levels of tPA activity in ACS group were significantly lower than those in normal group (P<0.01). The change of PAI-1 activity was significantly higher than that in normal group (P<0.01). Plasma concentrations of GPⅡb, Ⅲa in ACS group were significantly higher than those in normal group (P<0.01). In ACS group, tPA activity negatively correlated with concentration of GPⅡb and GPⅢa(r=-0.631 5,-0.572 8, respectively;P<0.01).PAI-1 activity negatively correlated with tPA activity(r=-0.660 7, P<0.01),positively correlated with concentration of GPⅡb and GPⅢa (r=-0.690 1,0.712 1,respectively;P<0.01). Conclusions: This has been shown by the elevated PAI-1 activity and the decreased tPA activity and elevated abnormal activity of platelet in patients with early non-Q wave ACS. It existed correlation between fibrinolytic activity and the activity of platelet. To measure plasma levels of tPA and PAI-1 activities, and the concentrations of platelet GPⅡb and GPⅢa is helpful to treat patients with ACS early.