急诊PTCA及支架术前后血清vWF的变化及临床意义

Changes of Serum von Willebrand factor before and after PTCA and in-stent inplantation

目的:本文通过测定急性心肌梗死(AMI)病人在急诊经皮冠状动脉腔内成形术(PTCA)及支架术前后血清血管假血友病因子(vWF)的含量,探讨急性心肌梗死病人在急诊PTCA及支架术后血小板的活化状态及内皮损伤和修复情况。方法:选取在发病12d内行PTCA及支架置入术治疗的急性心肌梗死病人15例,分别在术前、术后即刻、术后1d及术后24d采静脉血,用免疫浊度法测vWF的含量。结果:PTCA及支架术前vWF的含量明显高于正常对照组(P<0.01)。术后即刻较术前轻微增高(P>0.05),术后1d与术前相比显著增高(P<0.01),术后24d较术前明显下降(P<0.01)。但仍高于正常对照组(P<0.01)。结论:急性心肌梗死病人在PTCA及支架术前存在内皮损伤和血小板的活化,在PTCA及支架术后血小板的活化呈现下降趋势,损伤的内皮逐渐修复,血检再形成能力下降。

Objective:Objective:To assess the effect of the plasma level of Von willebrand factor(vWF)before and after Percutaneous transluminal coronary angioplasty(PTCA)and in-stent implantation on patients with acute myocardial infarction(AMI).Methods:15 patients with AMI who underwent immediate PTCA and in-stent implantation within 12 hours.Blood samples were obtained from vein before and immediately after PTCA and at the first hour,the 24 th hour after the procedure respectively.vWF was measured by immune turbidity.Results:The plasm level of vWF(%)in AMI patients were higher than that of 20 healthy volunteers before PTCA and in-stent(p<0.01).It increased slightly immediately affter PTCA and in-stent(p>0.05)and increased significantly at the first hour after the procedure(p<0.01).It decreased at the 24 th hour after the procedure(p<0.01),but it was higher than that of 20 healthy volunteers(p<0.01).Conclusion:There were endothelial lesion and platelet activation in AMI patients before PTCA and in-stent.The endothelial lesion reached the peak levels at the first hour and reconstructed gradually at the 24 th hour after procedure.