房颤患者纤溶系统的变化及其临床意义

Changes of plasma fibrinolytic parameters and their clinical significance in patients with atrial fibrillation.

目的探讨非瓣膜性房颤患者纤溶系统的变化及其临床意义。方法选择2004年8月至2005年1月在我院就诊的100例非瓣膜性房颤患者,根据是否发生缺血性脑卒中(简称脑卒中)分为两组,房颤1组为未发生脑卒中者,房颤2组为发生脑卒中者,每组50例。入选同期50例健康体检者为正常对照组。对房颤患者和健康者测定血浆中组织型纤溶酶原激活物(t!PA)、纤溶酶原激活物抑制剂!1(PAI!1)、纤维蛋白原(Fg)。结果单因素分析结果显示:房颤1组和房颤2组患者的血浆t!PA、PAI!1、Fg水平显著高于对照组(P<0.001);房颤2组患者的血浆t!PA、Fg水平显著高于房颤1组(P<0.05﹚;PAI!1水平在两组房颤患者间无显著性差异。多因素分析结果显示:t!PA、PAI!1、Fg水平均与卒中发生显著相关。结论房颤患者纤溶活性降低,发生脑卒中者的低纤溶状态较房颤无脑卒中者更为明显,这可能是房颤患者易发生脑卒中的机制之一。

Objective To investigate the changes of plasma fibrinolytic parameters in patients with nonvalvular atrial fibrillation and to explore their clinical significance. Methods One hundred patients with nonvalvular atrial fibrillation were divided into 2 groups, one group without stroke （groupl, n=50） and the other with stroke （group 2, n=50）. The healthy control group included 50 healthy subjects. Plasma tissue plasminogen activator （t-PA） level and plasminogen activator inhibitor type-1 （PAI-1） level were assayed using enzyme-linked immunoassay. Fibrinogen （Fg） were measured. Resuits In univariate analysis, compared with the healthy control group, patients with atrial fibrillation had significant increase of Plasma t-PA ,PAI-1 and Fg level. Plasma t-PA and Fg level was higher in group 2 than that in groupl. There was no significant difference in the level of PAI-1. In multivariate analysis, t-PA, PAI-1 and Fg were associated with stroke. Conclusions Patients with atrial fibrillation are at a hypofibrinolytic state, especially in group 2. This may contribute to the increased risk of stroke.