D-二聚体定量测定在AMI溶栓治疗监测中的应用

Application of Quantitative Measurement of Plasma D-dimer Contents for Monitoring Thrombolytic Therapy in Patients with Acute Myocardial Infarction(AMI)

目的:观察急性心肌梗死(AM I)患者溶栓治疗前后D-二聚体含量的变化,探讨在AM I患者溶栓治治疗监测中的应用。方法:对46例AM I患者,测定在溶栓治疗前及治疗后1h、2h、4h、6h、8h、12h、24h、48h、72h、168h血浆D-二聚体的含量及正常对照组30例D-二聚体含量。结果:再通组与未通和未溶栓组比较,溶栓治疗前无显著差异(P>0.05),溶栓治疗后再通组与其它两组有非常显著的差异(P<0.01),于溶栓后6h达高峰。结论:D-二聚体定量测定在AM I溶栓治疗监测中,是一项非常有价值的指标,与溶栓治疗效果有密切相关性。

Objective To explore the applicability of determination of changes of plasma D - dimer contents for monitoring the efficacy of thrombolytic therapy in patients with AMI. Methods Plasma D - dimer contents were measured repeatedly in 46 patients with AMI, i.e. before thrombolytic therapy and 1h, 2h, 4h, 6h, 8h, 12h, 48h, 72h, 168h later both in the 33 patients receiving thrombolytic therapy as well as in the 13 patients without thrombolytic therapy. A single determination in 30 healthy subjects served as control. Re- suits With angiography, 22 of 33 patients receiving thrombolytic therapy were proved to be successfully treated and 11 were failures. Serum D - dimer contents were about the same in the two groups of patients before thrombolytic therapy. In the successfully treated group, the D -dimer contents rose immediately after thrombolytic therapy （at lh） and reached the peak early （6h）. In the failures, the rose of D - dimer contents began at 2h after treatment and reached the peak later （8h）. Differences between the D - dimer contents of the two groups at 1 h, 2h, 4h, 6h were all significant （ P 〈 0.01, higher in the successfully treated group）. A rapid decline of D - dimer contents after peak was characteristic in the successful group. In the 13 patients without thrombolytic therapy. The D - dimer contents rose only slightly and slowly, with a low peak about half of that in the two other group） at 72h. Conclusion Dynamic changes of serum D - dimer contents after thrombolytic therapy might reflect the therapeutic result and should be carefully monitored.