急性心肌梗死患者再灌注前后血栓调节蛋白水平的变化及意义

Significance of the changes of plasma thrombomodulin in the patients with acute myocardial infarction before and after reperfusion therapy

目的测定急性心肌梗死(AMI)患者再灌注治疗前后血栓调节蛋白(TM)水平变化并探讨其临床意义。方法60例我院急诊AMI患者确诊AMI后即刻和再灌注治疗后第3天采集标本,12例对照者空腹采集标本,应用固相夹心法酶联免疫吸附试验(ELISA)方法测定血浆TM水平。结果AMI组再灌注治疗前后血浆TM水平均高于对照组(P<0.05);就诊时ST段抬高心肌梗死(STEMI)组血浆TM水平与非ST段抬高心肌梗死(NSTEMI)组比较差异有统计学意义(P<0.05);再灌注治疗后第3天急诊溶栓+补救PCI组血浆TM水平升高最显著(P<0.05);AMI再灌注治疗后有并发症组就诊时血浆TM水平与无并发症组比较差异有统计学意义(P<0.05),再灌注治疗后第3天两组TM水平比较差异有统计学意义(P<0.01)。结论血浆TM水平变化与急性冠脉血管闭塞性损害有关,可以作为评价再灌注对微血管损伤程度的辅助指标。

Objective To determine the plasma thrombomodulin （TM） levels in the patients with acute myocardial infarction before and after reperfusion therapies and to evaluate the clinical significance. Methods 60 consecutive patients with AMI who accepted reperfusion treatments in our emergency department. Venous blood samples were taken as the diagnosis of AMI was confirmed, and on the 3rd day after reperfusion therapy. Fasting venous blood was obtained from 12 normals as control group. The plasma levels of TM were determined by enzyme linked immunosorbent assay （ ELISA ）. Results The levels of TM in patients with AMI before and after reperfusion therapies were higher than those in control group （P〈0.05）. There was significant difference in the levels of TM between STEMI group and NSTEMI group before reperfusion therapy （ P 〈 0.05）. The levels of TM in the group with PCI after the thrombolysis were higher than those of other reperfusion groups on the 3rd day after reperfusion （ P 〈0.05 ）. The levels of TM before reperfusion therapy in AMI patients with complications were higher than those without complications, which changed more significantly on the 3rd day after reperfusion （ P 〈 0.01 ）. Conclusion The changes of plasma TM correlated with acute vascular occlusion injuries. Plasma levels of TM might be assistant index to evaluate capillary injuries after reperfusion therapy.