血管内皮细胞损害与急性冠脉综合征患者凝血-纤溶状态改变的关系

Relationship between vascular endothelial cell injury and blood coagulation and fibrinolysis in acute coronary syndrome patients

目的研究血管内皮细胞损害与急性冠脉综合征(acute coronary syndrom e,ACS)患者凝血-纤溶状态改变的关系,为临床治疗提供依据。方法以健康体检者35例,稳定型心绞痛患者35例为对照,回顾性分析了2003年1月至2005年7月,我院收治的35例ACS患者的循环内皮细胞(CEC)、血管性假血友病因子(vWF)、血浆纤溶酶原(PLG)、血浆组织型纤溶酶原激活物(tPA)活性、血浆纤溶酶原激活物抑制物(PAI),D-二聚体(D-D)及抗凝血酶Ⅲ(AT-Ⅲ)的测定值。结果ACS患者的tPA、PLG及AT-Ⅲ活性明显低于正常对照及稳定型心绞痛组(P<0.01),但CEC、vWF及PAI、D-D水平明显高于后者(P<0.01)。CEC与vWF、D-D水平呈显著正相关(rvWF=0.68,rD-D=0.68,P<0.05)。结论血管内皮细胞损害是ACS患者凝血-纤溶病理改变的重要原因,CEC、vWF及D-D可作为疾病严重程度的判断指标。

Objective To explore the relationship between vascular endothelial cell （VEC） injury and changes of blood coagulation and fibrinolysis indexes in acute coronary syndrome （ACS） patients. Methods The plasma levels of the Von Willeband Factor （ vWF）, PLG, tPA, PAl, D-dimer（D-D） and AT-Ⅲ in 35 early traumatic shock patients were analyzed retrospectively, with 35 healthy persons and 35 stable angina pectoris （SAP） patients as controls. Results The levels of t-PA, PLG and AT-Ⅲ were lower, but CEC, D-D, vWF and PAI were higher in ACS group than that in control groups. There was a close positive correlation between D-D, vWF and CEC in ACS group （rvWF =0.68, rD-D =0.68, P 〈0. 05）. Conclusion VEC injury plays an important role in the pathogenesis of blood coagulation and fibrinolysis in ACS patients. CEC, vWF and D-D can be used as a good reference for judging the severity of ACS.