缺血性心肌病心力衰竭患者纤溶参数异常的研究

Clinical study of the abnormalities of plasma fibrinolytic parameters in ischemic cardiomyopathy patients with heart failure

目的探讨缺血性心肌病心力衰竭时纤溶参数的变化及评价药物干预的效果。方法测定92例缺血性心肌病心力衰竭患者(心功能Ⅱ～Ⅳ级)的血浆组织型纤溶酶原激活剂(tPA)及其抑制物(PAI1),D二聚体(Ddimer)水平。43例心功能Ⅱ级患者随机分为雷米普利组和替米沙坦组,治疗3个月后重复测定血浆标志物。结果不同程度心力衰竭患者的纤溶参数间存在明显差异(P<001)。雷米普利组治疗前后血浆纤溶参数水平无明显变化(P>005)。替米沙坦治疗后血浆纤溶参数水平有显著改善(P<001),但与对照组比较差异仍有显著意义(P<001)。结论缺血性心肌病心力衰竭存在纤溶系统异常,并与心力衰竭的严重程度密切相关。ARB可改善纤溶参数,但血管紧张素转换酶抑制剂未见此作用。

Objective To explore the abnormalities of plasma fibrinolytic parameters and evaluate drug interference in ischemic cardiomyopathy patients with heart failure.Methods The levels of plasma plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),D-dimer were observed in 92 patients[New York Heart Association(NYHA) class Ⅱ～Ⅳ] in ischemic cardiomyopathy patients with heart failure.45 patients of NYHA class Ⅱ were randomly divided into two groups:ramipril group,telmisartan group.3 months after drugs administration,plasma fibrinolytic parameters were examined again.Results There were significant differences in the levels of fibrinolytic parameters with more severe symptoms(NYHA class Ⅱ～Ⅳ).After telmisartan was introduced,the levels of D-dimer,PAI-1(P<0.01,respectively) were significantly decreased and the level of t-PA significantly increased(P<0.01).No significant changes were found in ramipril group(P>0.05).But there was still significant difference between telmisartan group and the control group(P<0.01).Conclusions The abnormalities of plasma fibrinolytic parameters are present in ischemic cardiomyopathy patients with heart failure,especially in those with more severe NYHA class.Treatment with ARB can correct the abnormalities of plasma fibrinolytic parameters,however the addition of ACEI is not effective.