急性脑梗死患者尿激酶静脉溶栓过程中血浆凝血酶原片断1+2和D-二聚体的动态变化及其临床意义

The value of changes of plasma prothrombin fragment 1+2 and D-dimer during intravenous thrombolysis with Urokinase in patients with acute cerebral infarction

目的探讨发病6h内的急性脑梗死患者行尿激酶静脉溶栓过程中,血浆凝血酶原片断1+2(F1+2)和D-二聚体动态变化及其临床意义。方法应用酶联免疫吸附试验法(ELlSA),对45例发病6h内接受尿激酶静脉溶栓治疗的急性脑梗死患者溶栓前和溶栓后1、2、3、6、12、24、48、72和96h末梢血的血浆F1+2和D-二聚体的变化进行动态监测。根据溶栓后24h内CT、MRI检查结果,再将45例患者分为溶栓成功组、溶栓不成功组和出血组,并选择45名体格检查健康者为对照组,分析F1+2和D-二聚体变化与溶栓安全性和有效性之间的关系。结果尿激酶静脉溶栓前患者血浆F1+2和D-二聚体比对照组明显增高(P＜0.05)。脑梗死患者在尿激酶静脉溶栓后变化如下：①溶栓成功组：F1+2和D-二聚体大约在用药后2h达高峰,分别为(5.5±0.9)μg／L和(5.2±0.9)mg／L,然后迅速下降,用药后24h血浆D-二聚体含量仍然是用药前的4倍,约72h恢复至用药前水平。②溶栓不成功组：F1+2峰值出现在溶栓后6h左右,为(5.0±0.8)μg／L；D-二聚体大约在用药后2h达高峰,为(3.7±0.9)mg／L,峰值明显低于溶栓成功组。③出血组：F1+2和D-二聚体大约在用药后2h迅速达高峰,分别为(5.0±0.7)μg／L和(5.5±0.5)mg／L。结论血浆F1+2和D-二聚体溶栓前后的动态监测,对急性脑梗死尿激酶静脉溶栓效果判断和溶栓后出血风险的预测,有一定的临床意义。

Objective To study the dynamic monitoring of plasma prothrombin fragment F 1 ＋ 2 and D-dimer during intravenous thrombolysis with urokinase in patients with acute cerebral infarction within 6h after onset. Methods The level of plasma F 1 ＋ 2 and D-dimer of 45 patients with acute cerebral infarction were monitored by ELISA before and after thrombolysis, which were done before and 1, 2, 3, 6, 12, 24, 48, 72 and 96 h after they received Urokinase intravenously. The correlation among the level of D-dimer, F 1 ＋2, the clinical effects and reliability of Urokinase were compared with that of 45 controls. Results The levels of plasma F 1 ＋ 2 and D-dimer in patient group were significantly higher than that in controls before Urokinase treatment （ all P 〈 0. 05 ） . The treatment group was divided in three subgroups.In the successful thrombolysis subgroup, F 1＋ 2 and D-dimer reached peak at the 2nd hour after Urokinase infusion[ （5.5 ± 0.9）μg/L, （5.2±0. 9） mg/L] , then decreased quickly. The level of D-dimer was as four times higher as baseline at the 24th hour, and came down to baseline at 72 h. In failure subgroup, the level of F 1 ＋ 2 was reached the peak at the 6th hour after treatment [ （5.0 ± 0. 8） ] μg/L, and the Ddimer peak appeared at the 2nd hour [ （ 3.7 ±0. 9 ） mg/L], which was lower than that of successful thrombolysis group, both F 1 ＋ 2 and D-dimer were decreased quickly, and kept slight higher than baseline. in hemorrhagic subgroup： F 1 ＋2 and D-dimer reached the peak at the 2nd hour after thrombolysis [ （5. 0 ±0. 7） μg/L, （5.5 ±0. 5 ） mg/L] . The levels of F 1 ＋ 2 decreased quickly, reach the level below the baseline at 6 - 12 h, while the level of D-dimer went down slowly. Conclusion The diversified levels of F 1 ＋ 2 and D-dimer before and after Urokinase treatment in acute cerebral infarction showed some extent instructive significance for monitoring the effects of thrombolysis with Urokinase, diagnosis of reocclusion and alarm the risk of Urokinase relevant hemorrhage.