凝血纤溶指标的变化与缺血性心脏病的关系

Changes of Coagulative and Fibrinolytic Parameters in Ischemic Heart Disease

目的：探讨缺血性心脏病患者的凝血、纤溶变化及其临床意义，并对部分患者跟踪观察。方法：用高效液相色谱仪测定２６例急性心肌梗死患者，２６例不稳定性心绞痛患者，以及２０例正常人的尿纤维蛋白肽Ａ（ＦＰＡ）；并用相应方法同步测定了血浆Ｄ－二聚体（Ｄ－ｄｉｍｅｒ）含量、组织型纤溶酶原激活物（ｔＰＡ）及其抑制剂（ＰＡＩ）活性。结果：急性心肌梗死、不稳定性心绞痛患者较正常对照组尿纤维蛋白肽Ａ值增高，血浆Ｄ－二聚体水平、ＰＡＩ活性升高，ｔＰＡ活性降低。且急性心肌梗死与不稳定性心绞痛患者之间上述指标也存在显著性差异。结论：研究结果提示凝血纤溶系统的变化在缺血性心脏病的发生、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 and fibrinolytic parameters with ischemic heart disease(IHD). Methods:Urine fibrinopeptide A(FPA),plasma D dimer,tissue type plasminogen activator(tPA)and plasminogen activator inhibitor(PAI)activities were determined in inpatients with IHD [26 acute myocardial infartion(AMI);26 unstable angina pectoris,(UAP)]and 20 normal controls. Results:Urine FPA,plasma D dimer and PAI activity were significantly higher in patients with AMI and UAP than in controls( p< 0 001),and also higher in patients with AMI than those with UAP( p< 0 001).Plasma tPA activity was lower in patients with AMI than with UAP( p< 0 001),and also lower in patients with UAP than in controls( p< 0 001). Conclusion:It suggests that the alteration of coagulative and fibrinolytic systems play an important role in the pathogenesis and development of IHD.Studying the indexes of coagulation and fibrinolysis can help us to explore the pathogenesis,clinical classification and prognosis of IHD.