冠心病患者凝血机制的改变及其临床意义

CHANGES OF COAGULATIVE AND FIBRINOLYTIC PARAMETERS IN CORONARY HEART DISEASE

目的:探讨不同类型的冠心病患者凝血、纤溶变化及其临床意义。方法:CA-1500型血凝仪检测60例冠心病患者凝血酶原时间(PT)、部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、组织型纤溶酶原激活物(t-PA)、抗凝血酶Ⅲ(AT-Ⅲ)等凝血和纤溶指标的改变。结果:冠心病患者与正常对照组比较,血浆PT、APTT、TT、D-D、FIB均增高,t-PA活性降低,AT-Ⅲ降低(P<0.05)。急性心肌梗死组和不稳定型心绞痛组D-D、FIB含量明显高于对照组及稳定型心绞痛组(P<0.01);急性心肌梗死组D-D、FIB含量高于不稳定型心绞痛组(P<0.05);对照组、稳定型心绞痛组间差异无统计学意义(P>0.05)。结论:冠心病患者体内存在着高凝状态和继发性纤溶活性增强,提示凝血纤溶系统的变化在冠心病的发生、发展中起着重要作用,研究凝血、纤溶指标对探讨其发病机制及判断预后可能有一定帮助。

Objective： To explore the alterations of coagulative. Method： Prothrombin time （PT）, activated partial thrombopilastin time （APTT）, fibrinogen （FIB）, D- dimer （D- D）, tissue - type plasrninogen activator （t - PA）, antithrombin antigenⅢ （AT-Ⅲ） of 60 CHD patients were measured by Sysmex CA - 1500 coagulation apparatus. 20 stabe angina pectoris （SA）, 20 unstabe angina pectoris （UA） and 20 acute myocardial infarction （AMI） were investigated in this study. Results： The parameters of PT, APTT, TT, D- D, FIB were increased, and t- PA, AT- Ⅲ were declined in CHD patients compared with normal controls （P〈0.05）. In patients with AMI and UA D-D and FIB were significantly higher than the controls and SA group （P〈0.01） ; Moreover D-D and FIB levels were increased in patients with AMI compared with UA （P〈0.05）. There was no significant difference between the controls and SA group （P〉0.05）. Conclusion： It is suggested that the alterations of coagulative and fibrinolytic systems play an important role in the pathogenesis and development of CHD. Studying the indexes of coagulation and fibrinolysis may help us to explore the pathogenesis, clinical classification and prognosis of CHD.