急性ST段抬高型心肌梗死患者血浆D二聚体水平变化分析

The Analysis of Plasma D-dimer in Patients with Acute ST Segment Elevation Myocardial Infarction.

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者血浆D二聚体水平的变化及其临床意义。方法:选择STEMI患者并急性心功能不全者40例,并阵发性房颤者20例和无明显并发症的30例为对照组进行比较。测定入院时患者的血浆脑钠素(BNP),肌钙蛋白T(cTnT),利用免疫比浊法测定D二聚体水平以及利用超声心动图测定其左室射血分数(LVEF)。结果:在STEMI患者中,合并心功能不全及阵发性房颤者的血浆D二聚体水平均明显高于对照组(P<0.05),在STEMI并心功能不全患者其D二聚体水平与LVEF呈负相关(r=-0.589,P<0.01),与血浆BNP水平呈正相关(r=0.749,P<0.01);STEMI合并房颤者其D二聚体水平与cTnT水平呈正相关(r=0.679,P<0.05)。结论:急性ST段抬高型心肌梗死患者中,出现急性心功能不全和阵发性房颤时血浆D二聚体水平明显升高,提示D二聚体可作为预测STEMI患者发生近期并发症以及评估病情的指标之一。

Objective: To investigate the change and clinical significance of D-dimer in patients with acute ST segment elevation myocardial infarction(STEMI). Methods:40 STEMI patients complicating acute cardiac insufficiency, 20 STEMI patients with paroxysmal atrial fibrillation and 30 STEMI patients with non-complication were observed plasma concentration of B-type natriureric peptide(BNP), troponin T(cTnT) and D-dimer. Besides, the left ventricular ejection fraction (LVEF) of above patients were determined by ECHO. Results:The D-dmier in STEMI patients complicating acute cardiac insufficiency group and complicating paroxysmal atrial fibrillation group were significantly higher than that in the non-complication STEMI patients group respectively(P<0.05). Moreover, the concentration of plasma D-dimer in the STEMI patients complicating acute cardiac insufficiency group had a negative correlation with LVEF(r=-0.589,P<0.01) and a positive correlation with BNP level(r=0.749,P<0.01). In addition, the concentration of plasma D-dimer in STEMI patients complicating paroxysmal atrial fibrillation group had a positive correlation with plasma cTnT(r=0.679,P<0.05). Conclusion: The plasma D-dimer level significantly increases in STEMI patients who complicate either acute cardiac insufficiency or paroxysmal atrial fibrillation, which indicates that D-dimer could be one of factors to predict short-term complications and assess patient's state in STEMI patients.