急性脑梗死患者用药前后血浆生物分子的变化

Changes of plasma biomolecules in patients with acute cerebral infarction before and after treatment

目的探讨急性脑梗死(AC I)患者血浆生物分子的变化及服用蚓激酶与阿司匹林(ASA)对其的影响。方法随机将70例AC I患者按用药分为蚓激酶组、ASA组、蚓激酶与ASA联合组,另设正常对照组。应用ELISA法检测血浆中P-选择素、D-二聚体(D-D)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)、纤溶酶-抗纤溶酶复合物(PAP)、凝血酶-抗凝血酶复合物(TAT)、同型半胱氨酸(Hcy)和凝血酶可激活的纤溶抑制物(TAFI)。比较治疗前后各检测指标的变化;通过ROC曲线比较各检验指标对AC I的诊断价值。结果AC I患者治疗前各指标均显著高于正常对照组(P<0.05,P<0.01)。D-D与t-PA、PAI-1、P-选择素、TAT、PAP呈正相关。治疗后ASA组各项指标没有显著变化(P>0.05);蚓激酶组PAP有显著变化(P<0.05);蚓激酶与ASA联合组PAP和PAI-1有显著变化(P<0.05)。D-D、TAFI活性(TAFI:a)和抗原(TAFI:Ag)比其他血浆生物分子的灵敏度和特异性高。结论t-PA、PAI-1、P-选择素、TAT、PAP、D-D、Hcy、TAFI:a、TAFI:Ag均可以作为AC I的诊断指标,D-D、TAFI:a、TAFI:Ag的灵敏度和特异性高于其他项,在判断AC I时具有较高临床价值。在临床用药方面,ASA与蚓激酶同时给药对血浆生物分子的影响比单用其中一种药物更显著。

Objective To study the changes of plasma biomolecules in patients with acute cerebral infarction （ACI） and the potential influences from lumbrukinase and aspirin （ASA）. Methods Seventy patients with ACI were randomly divided into three groups according to the ways of administration ： lumbrukinase group（ n = 26） , ASA group（ n = 24） and lumbrukinase ＋ ASA group （ n = 20）. Plasma levels of P-selectin, D-dimer（D-D） , tissue plasminogen activator （t-PA） , plasminogen activator inhibitor-1 （PAI-1） , plasmin-antiplasmin complex （ PAP）, thrombin-antithrombin complex （TAT） , homocysteine （Hcy） and thrombin-activatable fibrinolysis inhibitor （TAFI） were measured in these patients with ACI and normal individuals （n = 20） by ELISA method. Changes of these parameters were detected before and after the treatment, and the diagnostic efficiencies for ACI were compared by receiver characteristic curve （ROC）. Results Before the treatment, all the parameters in patients with ACI were significantly higher than those in the healthy controls （ P 〈 0.05, P 〈 0.01 ）. The plasma level of D-D was positively related to those of t-PA, PAI-1, P-selectin, TAT and PAP. After the threatment, the plasma levels of biomolecules in the ASA group did not change significantly （ P 〉 0.05）. However, there were significant changes of PAP in the lumbrukinase group （P 〈0.05） and PAP and PAI-1 in the lumbrukinase ＋ ASA group （P 〈0. 05）. D-D, TAFI： Ag and TAFI：a were more sensitive and specific than the other plasma biomolecules. Conclusion Either t-PA, PAI-1, P-selectin, TAT, PAP, D-D, Hcy, TAFI： a and TAFI： Ag may serve as diagnostic tool for ACI, and D-D, TAFI： a and TAFI： Ag are better in sensitivity and specificity. Treatment with lumbrukinase ＋ ASA may lead to more significant changes in plasma biomolecules.